§ 3. Mr. Cousins
To ask the Secretary of State for Health whether he intends that reduction in length-of-stay targets should form part of hospital contracts.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)
Length of stay could be one element which health authorities might discuss with hospitals when reaching an agreement on a contract as it might be an important factor in determining how many patients could be treated within the resources available. The contract itself need not, however, specify how long a patient should stay in hospital.
§ Mr. Cousins
Does the Minister accept that it would be disgraceful to build into a system for hospital contracts financial pressures that could lead to patients being discharged before their social circumstances in the community are right and before their medical needs are correct? Does he agree that that would simply be shifting the cash responsibility from the hospital contract on to social and community service—another sector of the budget?
§ Mr. Freeman
The quality of care available in hospital is not related to and cannot be correlated with the length of stay of patients. The average length of stay of patients over the past 10 years has decreased from 13 days to 10 days. That is a reflection of the substantial increase in day surgery and of advance in medical technology.
§ Mr. Redwood
How serious is the Minister about improving quality of treatment? Will he use the contracts as one way of improving quality? What progress is being made with the appointments systems as part of that package? Could those also be enforced through the contracts?
§ Mr. Freeman
Quality is extremely important in hospital care. I commend to my hon. Friend and the House the new document published by my right hon. and learned Friend the Secretary of State for Health on 20 June entitled "Self-governing Hospitals", which goes into some detail about the importance of quality in contracts for care of patients in hospital.
§ 4. Mr. Roy Hughes
To ask the Secretary of State for Health what representations he has received from professional bodies and trade unions concerning the Government's review of the National Health Service.
§ Mr. Hughes
Would it not he wiser if the Secretary of State were more candid with the House and admitted that all those bodies have been positively hostile to his proposals, believing that they can cause serious damage to patient care? If he did so, he could scrap his proposals and go back to the drawing board. Certainly many of his Back-Bench Members would he relieved.
§ Mr. Clarke
I fear that if I say anything of the kind, it will be a long way from the truth. Although there is a great deal of public campaigning, I am having extremely helpful and constructive meetings not only with those who lead the professional organisations, but with large numbers of their members. It is obvious that the process of implementing the reforms is already under way, because the great bulk of them have been readily accepted by the majority of the medical profession and others.
§ Mr. Clarke
I can. The whole basis on which we have proceeded is to issue a White Paper and working documents inviting constructive contributions. We intend to work out in detail matters such as self-governing hospitals and general practitioners' practice budgets with willing volunteers. I keep telling my organised critics that they must choose whether they wish to remain spectators on the sidelines, merely shouting abuse, or to take part in constructive and sensible discussion on how the Health Service might be improved.
§ Mr. Grocott
If it is true that the Minister is listening to constructive criticism, which some of us have reason to doubt, can he give the House one or two concrete examples of the way in which his proposals have changed as a result of the almost universal objections that he has received?
§ Mr. Clarke
I spent 10 hours in the time-honoured method of beer and sandwiches in an almost locked room resolving difficulties over the general practitioners' contract and bringing to an end a very protracted period of negotiation.
If the hon. Gentleman would look at our latest documents for those interested in self-government, he will find that there is an overall statement and a working paper describing financial and contractual difficulties, and that thinking has moved on quite a lot. Since we produced the White Paper we have put in much more detail, precisely in response to the detailed questions that have been put to us.
§ Dr. Reid
I congratulate the Minister on being more restrained in his comments about doctors than he was at the previous Question Time. A careful reading of Hansard for the previous Question Time will reveal that he and his hon. Friends branded the medical profession and doctors 820 as being unscrupulous, misleading and liars. Will the Minister take the opportunity to dissociate himself from the comments that were made on that occasion about the medical profession?
§ Mr. Clarke
I would normally rely on the hon. Gentleman to read Hansard with a little more care than he appears to have been doing. Both I and many of my hon. Friends have made strong comments about some of the advertising material put out by the British Medical Association. We believe that it is an extremely unscrupulous campaign. We have made no attacks on the medical profession or on individual doctors, except on those doctors who are misleading their patients and are making wild allegations that they know to be untrue. As I said in reply to a previous question, there is an enormous gulf between some of the public protestations on behalf of the associations and what is said in private discussion with the leaders of the BMA and others. The BMA is obviously in favour of better financial management systems, medical audit and money following the patient. We should build on that and ignore all the rather silly propaganda that appears in the newspapers.
§ Dame Jill Knight
Will my right hon. and learned Friend always bear it in mind that the reactions to the review from the medical profession, especially the BMA, are as predictable as Pavlov's dogs? It has always rejected every suggestion for reform in the National Health Service. Does he agree that, if he had listened to it and had not pressed through the reform of the limited list, we would have had £73 million per annum less to spend on patients?
§ Mr. Clarke
My hon. Friend and I can remember many such campaigns that the BMA has run, under successive Governments, against suggestions for reform. On the strength of my latest meeting with the BMA leadership I am more hopeful on this occasion. The BMA began by accepting our aims and various features of the reforms, but it has not yet been able to put forward any positive proposals of its own that might further those aims. However, the initial outright rejection that is customary from the BMA has already begun to modify.
§ Mr. Robin Cook
May I give the Secretary of State the thanks of the official Opposition who, since the publication of his White Paper, had our best election results for 20 years? It is about time that he started listening to what the electorate is trying to tell him. Having told my hon. Friend the Member for Newport, East (Mr. Hughes) that he has received 8,000 representations, will he now share with the House the breakdown of those representations and tell us how many supported his White Paper and how many wanted him to drop the whole idea and get back to the real problems of axed beds and closed wards?
§ Mr. Clarke
I am afraid that I do not see my role in life as a good Samaritan to the Labour party. My principal duty is to carry through a process of reform that will produce a better National Health Service. Sooner or later, the Labour party must decide what it is saying rather than maintain its present outright opposition to everything that we propose.
I am glad to say that many of the 8,000 representations that I have received deal with the serious detail of the White Paper and, for that reason, they do not break down 821 into yes and no answers. It is only the Labour party which is continuing to reject outright each suggestion that happens to come from the Government.
§ Sir Peter Hordern
Has not the unscrupulous and misleading campaign carried out by the BMA so confused the doctors that they do not know whether to sign the contracts that have been placed before them and which the BMA has recommended?
§ Mr. Clarke
I fear that that is the case. The BMA has run a strident campaign, but when it called a conference to endorse the deal that its leaders had negotiated with me it was unable to get consent. Now, no doubt, it is trying to explain it to many doctors who mistakenly fear that they will lose income as a result of the changes, and who also feel that they should be left to decide entirely for themselves what they do and how and when they do it. That is not the basis on which we should proceed given that the BMA began by agreeing with me that a new and better contract was required by April 1990.
§ The Minister of State, Department of Health (Mr. David Mellor)
No specific financial allocation has been made to health authorities for this purpose. However, health authority chairmen and senior National Health Service managers have attended national and regional conferences, and received written material and visual aids to help them to explain the proposals and their implications to NHS staff and the public. This commitment to communication will continue throughout the period of the implementation process.
§ Mr. Cox
Is the Minister aware that the document entitled "Working for Patients" contains an obligation to explain to patients the implication of the White Paper? Today we have repeatedly heard the Secretary of State bitterly condemning doctors who are seeking to do that because he does not like the points that they are making to their patients. Wandsworth health authority, whose area the hon. and learned Gentlemen and I represent, wants to explain the White Paper, but it cannot do so because it does not have the money. Therefore, the very people whom the White Paper is supposed to he about will not have the opportunity to have it explained to them or to have their queries answered. That is a typical example of the Government imposing decisions on the very people who will not be given any opportunity to voice their objections to them.
§ Mr. Mellor
A shortened version of "Working for Patients" has been made widely available to the public and there is ample opportunity for lively debates on the merits of the White Paper to be conducted in the local press. The hon. Gentleman knows that that is happening in our local press.
The hon. Gentleman knows that we have been working for patients in his constituency by building a new 700-bed, £35 million hospital—something inconceivable in the decade when the Labour party was in power, when capital spending was slashed to the bone. We shall continue to work in that constructive way for patients in Tooting.
§ Dame Elaine Kellett-Bowman
Does my hon. and learned Friend agree with the leading article in my local paper which pointed out that local communities would have to be deaf, daft, or both, if they were not already well aware of the Government's proposals? Does he accept that excellent hospitals such as that at Lancaster and outstandingly good general practitioners, who are already providing many of the services for which they are not yet paid, will benefit enormously, as will their patients?
§ Mr. Mellor
I am sure that what my hon. Friend says is right. The danger of a public debate arises if some people choose to use a debate about a great national service merely to spread propaganda, rather than truth, which means that the public debate becomes muddy. However, I am sure that the fact that the Government have proposals for improving patient care will stand us in good stead in the next decade when, as we all know, there will be unprecedented pressures on the NHS. It is better that we do that rather than act like those who throw mud around, but have no constructive proposals of their own.
§ Ms. Harman
Why is it that although local communities receive an unwelcome dose of Government propaganda about their Health Service proposals, they have no say as to whether their local hospitals should be opted out of their local health authorities? If the Minister really believes, as he says, that more Health Service decisions should be taken locally, why does he not give local people a ballot before their local hospital is opted out?
§ Mr. Mellor
There is a lack of coherence in the criticism from the Opposition. The Government were criticised by the hon. Member for Tooting (Mr. Cox) for apparently not having made money available to tell local people about the proposals and are now being accused of putting forward a barrage of propaganda. The hon. Lady knows that no National Health Service hospital will opt out of anything; it is simply a matter of whether it becomes self governing within the NHS. Parroting slogans like demented mynah birds does the Opposition no good because people will realise that self-governing status is quite different from opting out. The decision as to whether a hospital should have self-governing status, like other decisions made within the NHS, will depend on whether, having taken account of the different voices, there is a good management case for doing so. The NHS has never been run by ballot, and it will not be in the future.
§ 7. Mr. Colin Shepherd
To ask the Secretary of State for Health what will be the effects of the proposals for medical audit outlined in the White Paper "Working for Patients".
§ 16. Mr. Butterfill
To ask the Secretary of State for Health if he will explain the intended effects of the White Paper proposals for medical audit.
§ Mr. Mellor
The objective of the comprehensive system of medical audit proposed in the White Paper is to provide necessary reassurance to doctors, patients and management that the quality of medical care is under continual examination, and that clinical outcomes are being measured and thereby the best possible service provided for patients.
§ Mr. Shepherd
Does my hon. and learned Friend recall that at the outset there was considerable hostility to the concept of medical audit, but that with further 823 understanding there has been near-universal acceptance, and even welcome, of this valuable concept? Does my hon. and learned Friend think that, with careful consideration, the BMA might find some useful pointers for the future conduct of its campaign?
§ Mr. Mellor
My hon. Friend makes an interesting point. Clinical audit was pioneered by doctors and we are merely proposing to systematise it. As I made clear in an announcement to the House earlier this month, we made available £1 million for pilot projects, for which we have had enthusiastic applications across the length and breadth of the country. As my right hon. and learned Friend made clear at our last meeting with the BMA there was a welcome not only for that part of the White Paper, but for improved information systems, the concept of money following patients and so on. I hope that the public propaganda battle will soon come into line with the obvious measure of agreement which exists on a number of key points in the document.
§ Rev. Martin Smyth
Will nurses be included in the medical audit programme and how much money have the Government targeted to put the system into operation to provide the back-up to the National Health Service?
§ Mr. Mellor
The measurement of clinical outcomes will show the effectiveness of all parts of the clinical process. So far, the sum of money made available for pilot studies is in excess of £ 1 million. We shall obviously move forward and ensure that as this becomes systematised, fresh resources will be made available at every stage.
§ Mr. Hayes
I am sure that my right hon. and learned Friend the Secretary of State is not at all surprised that medical audit, which is about quality control, has been welcomed by all the medical professions. Is he encouraged by the fact that not only medical audit but money travelling with patients and resource management have been accepted by the BMA and other bodies? Does that not explode the myth that the medical profession is wholly opposed to the White Paper?
§ Mr. Mellor
I hope that that also demonstrates that a barrage of inaccurate propaganda will not drive the Government off the reforms. Then we can have more sensible discussion of the merits and the detailed application of the proposals, and less propaganda calculated to mislead rather than to shed light on what everyone knows to be the vital necessity to change the service to fit the 1990s, when it will be subjected to unprecedented pressure. I believe that as time goes on more and more people will be compelled to admit that there is much merit in our proposals.
§ Mrs. Mahon
When the Minister goes on his round of regional consultations with management, will he discuss medical audit in detail? Will he also tell us where his meeting with management in Leeds at 10 am on 11 July will take place? When I contacted his Department last week I could not find out.
§ Mr. Mellor
I shall communicate that to the hon. Lady willingly. The meeting is about self-governing hospitals, but there will be plenty of opportunities to discuss other key proposals in the White Paper.