Hospital Inspectorate (Hansard, 7 November 2001)

§ Tony Baldry (Banbury)

I beg to move, That leave be given to bring in a Bill to establish an independent inspectorate of hospitals to provide independent inspection of waiting lists, waiting times, hospital efficiency and clinical cleanliness.

The Bill is about standards in hospitals. Some 75,000 people had their operations cancelled last year, and nearly 300,000 people are waiting simply to get on an out-patient waiting list. The Bill will set up an independent body, so that when the Government talk about improvements in the NHS, patients will be able to see whether there is evidence of such improvements.

The independent hospital inspectorate that the Bill will establish will be very different from the Commission for Health Improvement. The commission says that it has influence, but there is no point in having influence if it does not lead to improvement. Clearly, an independent inspectorate is needed to respond to the recommendations of the Bristol inquiry and similar investigations, as well as to patients' concerns, to identify weaknesses in the NHS and impartially to ensure accountability.

Those objectives may be within the commission's remit, but the reality is rather more modest, as observed by a recent report in the Health Service Journal. It noted that few establishments in the NHS have experienced intervention. In the commission's first year, only four pilot reviews of acute trusts and two specialist investigations have been carried out, and that is a pathetic rate of inquiry. I very much doubt that Ofsted would have commanded any credibility if in its first year of operation it had inspected only four secondary schools and two primary schools.

Patients need to be sure that hospitals are adequately inspected now, not in four years. The Bill seeks to ensure that the tasks that the Commission for Health Improvement should be doing will be done. The same Health Service Journal report observes that a further problem with the commission is that its reports raise as many questions as they answer and prompt a further inquiry. That suggests that the traffic light system of classifying trusts may run into trouble.

There is little confidence in existing mechanisms to monitor standards in the NHS. The commission is clearly under pressure to claim success stories for the Government's NHS plan, which seriously calls into question its freedom. That is why the Bill calls for an independent NHS hospital inspectorate. Priority must be given to patients, not Government spin doctors trying to claim improvements when patently they are not taking place.

Even the Audit Commission finds that its informative reports have little influence on results. Let us consider its recent report on accident and emergency admissions. It found that, nationally, nearly one third more people are now waiting longer for such admissions. Last June, at the Horton general hospital in Banbury in my constituency, 27 people had to wait more than 12 hours in accident and emergency before they were seen. On average then, almost every day one person had to wait more than 12 hours, whereas a year earlier none had to do so. The situation in our hospitals is getting worse, not better. The Audit Commission finds itself repeating the 270 recommendations that it made five years ago. The Commission for Health Improvement is incapable of bringing about change, and the Audit Commission finds it hard to do so.

We have introduced adequate inspection systems in other public services, such as Ofsted, which has done an enormous amount to make schools' performance more transparent, to improve accountability and to drive up standards. The Bill will establish an inspectorate that would seek honestly to evaluate the strengths and weaknesses of NHS hospitals and trusts without scapegoating staff.

That brings me back to the Government's policy of traffic light classification of NHS trusts as green, yellow or red, depending on their performance. That has introduced a crazy situation whereby trusts in areas that are having difficulties have their budgets cut, but those in areas where things are going well have their budgets enhanced. Perhaps the Government should pause and reflect that almost all the trusts that were recently found to merit no stars for performance on indicators such as accident and emergency admissions and trolley waits were in the south-east. I find it difficult to believe that weaknesses in NHS management are such a geographical phenomenon.

Perhaps the real reason why hospitals and trusts such as the Oxford Radcliffe Hospitals NHS trust appear to perform so badly is as a consequence of staff shortages, especially shortages of nursing staff which are more acute and serious in the south-east. In Oxfordshire—a county where "long in-patient" performance is already 60 per cent. away from target—the Government's current policy will cause the position to worsen, as they take money away from the Oxford Radcliffe Hospitals NHS trust.

Furthermore, simply threatening to sack NHS managers and scapegoating NHS staff is no solution. It certainly does not help my constituents. I doubt that I am alone in receiving almost daily representations from constituents who are frustrated either by the length of time it has taken them to get treatment, or by the number of times that their operation has been cancelled.

From a large number of examples, let me offer a simple one. Last Saturday,. Graham came to see me. All he wants is an out-patient appointment at the audiology clinic at the Radcliffe infirmary where his hearing can be tested to determine which hearing aid might be the most suitable for him. He was referred to the hospital by his GP in January and was told that there would be a three-month wait for an out-patient appointment. When at the end of the three months he inquired when he would be seen, he was told that it would take a further 12 months. About 10 days ago—a week before he came to see me—he was told that he would have to wait a further 14 months. That is a total wait of almost 20 months for a straightforward out-patient appointment.

The outcome of the Government's current policies is that the problems in a county such as Oxfordshire, where "long out-patient" performance is a shocking 75 per cent. away from target, will simply get worse. Oxfordshire health authority is now having to identify cuts of 7 million before it is abolished on 1 April next year. As a consequence, trolley waits will continue at a high and unacceptable level, as will cancellations of operations.

There is a critical shortage of staff in the NHS in Oxfordshire: a recent count revealed that 377 of the 1,250 nursing posts were vacant. As my hon. Friends the 271 Members for Henley (Mr. Johnson), for Wantage (Mr. Jackson) and for Witney (Mr. Cameron)—all sponsors of my Bill—can testify, the people of Oxfordshire are becoming extremely frustrated and disillusioned by the continuing deterioration in the delivery of NHS services in their county. I suspect that trends in Oxfordshire are repeated in many other parts of the country, especially in the south-east.

What the NHS needs is more nurses, more staff and more money. The Government's policies will simply exacerbate the difficulties of NHS trusts that are in trouble. It is not possible further to reduce spending on health services while expecting health authorities such as Oxfordshire's to implement what in NHS jargon are called PIP and PIP2—patient improvement plans. How on earth is implementing such plans possible when one is cutting the budgets of local hospitals'? Even if the John Radcliffe hospital and Horton hospital could recruit a full complement of nurses, they cannot now afford to do so because they could not afford to pay them. Their ability to do so will be eroded even further by Government-imposed additional cuts to their budgets.

The Department of Health has instructed Oxfordshire health authority to implement cuts of £7 million in the financial year 2000–01. Those cuts are in addition to the cuts that the Oxford Radcliffe Hospitals NHS trust is expected to make in respect of the John Radcliffe hospital and Horton hospital, whose budgets have to be reduced by a further £4.5 million. Oxfordshire health authority's resource outlook for the coming year diplomatically observes that those cumulative cuts will entail "a reduction in aspirations".

There will be a substantial reduction in NHS services to my constituents and those of every Oxfordshire Member of Parliament, further exacerbated by the fact that Oxfordshire county council is simultaneously having to make substantial savings in its social services budget—savings of so draconian a nature that only those in the most urgent need are now likely to receive social services support. I do not expect the problem of bed blocking to be resolved this winter.

My Bill will ensure that when failings are found, there will be the necessary encouragement to ensure appropriate funding. That does not happen under the Commission for Health Improvement, nor under the Audit Commission. My Bill will introduce an independent NHS hospital inspectorate that will help to direct investment into hospitals that need assistance. That will be better for nurses, managers and patients.

My Bill will also establish an inspectorate that can watch where NHS funding goes at a time when the Government are somewhat chaotically restructuring the NHS. The Government's rhetoric in their NHS plan is that NHS restructuring will develop partnership and co-operation but I suspect that the reality will be—

§ Mr. Evan Harris (Oxford, West and Abingdon)

I agree with much of what the hon. Member for Banbury (Tony Baldry) said about the state of the NHS in 272 Oxfordshire, but I do not believe that the Bill would add to any inspection regimes that might exist to measure sensible outcomes. Indeed, it appears to focus on measures that are not sensible. I put it to the House that it is no good measuring silly things better. Mechanisms already exist for measuring the sensible things—health outcomes—that need to be measured.

It must be understood that the Government strategy for escaping responsibility for poor performance in the national health service is to shift the blame. They are doing that, first, through continuous structural change, to appear to be busy while making matters worse. Secondly, they insist on creating changes in working patterns, labelled "modernisation", which does not appear to have any influence on improved patient care, then criticise people who oppose that change because it is change for change's sake. The third prong of their strategy is to name and shame, which they do through league tables.

The creation of yet another inspectorate on top of those that already exist gives more weight to the idea that the problem of investment, staffing and morale is not the Government's failure, but a failure of some hospitals involving poor management or poor clinical care, and plays into the Government's hands. Current problems, including waiting lists, waiting times and clinical cleanliness, which appear in the motion moved by the hon. Gentleman, are not sensible measures of outcomes. Many of the outcome targets that the Government measured for their league tables were wholly dependent on trusts' ability to staff their hospitals, which involves the availability of clinical staff, as the hon. Gentleman said, the level of Government resources and, of course, trusts' ability to fiddle the figures.

Creating another inspectorate to measure how much the figures are fiddled does not do anything to improve patient care. Indeed, yet another inspectorate will simply play the Government's game of scapegoating. Waiting lists are merely a measure of activity; the more operations that are available on the health service, the greater the number of people waiting. The critical factor is average waiting time, not how many people are waiting. The continuing focus on waiting list numbers has distorted clinical priorities and has often led to people waiting longer. Rigid Government waiting-time targets create distortions themselves, as people are brought in to meet the 18-month, 15-month and 12-month—apparently soon to be six-month—limit at the expense of critically ill people who should be treated within 18 days or 18 hours. That is happening at the John Radcliffe and many other hospitals. Focusing on such measures through the proposed inspectorate or other inspectorates does not help.

Another flaw in the proposal is the suggestion that an inspectorate can sensibly measure hospital efficiency without taking effectiveness into account. Hospitals can be hugely efficient when they are 100 per cent. full, but they are not effective if they cannot admit anyone. If, by clinical cleanliness the hon. Gentleman means cross-infection rates, those should already be being measured by good clinical practice—clinical audit and clinical governance. If the Government focused on sensible outcome measures, I would be more prepared to welcome the measures that they have introduced through, for example, the Commission for Health Improvement, the continuing work of the Audit Commission, clinical governance and clinical audit, which ensure that those measures are accurately presented and publicised.

273 The Government have an incentive, not to look at real outcomes, which are getting worse, but to create league tables. If we ever focus on sensible outcome measures, mechanisms for assessing them already exist. To a certain extent, the quality agenda has been met by those measures; clinical revalidation of doctors and, I hope, other health professionals is assessed in a way that yet another inspectorate will not match. If anything, morale in hospitals is suffering because clinical staff, who are working hard, face a profusion of inspections. At the John Radcliffe, morale is already at rock bottom from the Government's scapegoating and the naming and shaming exercise of league tables; that is without the threat of yet another inspection, which will simply show that the hospital does not have the resources or staff.

I was delighted that the hon. Gentleman called for more nurses, beds and funding, as we have not heard that from his party before. However, we also need no more inspectorates and no more false measures.

I urge hon. Members to reject the Bill. Although we currently measure the wrong things badly, it will not help to measure the wrong things better.

Question put, pursuant to Standing Order No. 23 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business), and agreed to.

Bill ordered to be brought in by Tony Baldry,. David Amess,. David Cameron, Sir Sydney Chapman,. Robert Jackson,. Boris Johnson and. Andrew MacKay.