Baroness Thornton
To ask Her Majesty’s Government how they will ensure that patients will be seen in reasonable time by doctors and other primary care professionals following the publication of the revised NHS operating framework which removes NHS patient targets.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the revised NHS operating framework stops central performance management of process targets that have limited justification. The NHS must be free to manage services at a local level, and will be accountable to the patients and the public it serves. To ensure this, we shall continue to collect data measuring access. Incentives for timely access such as through the quality outcomes framework, the NHS constitution and the contractual regime remain in place.
Baroness Thornton
I thank the noble Earl for that Answer. He will recall that in 1992 his Government launched their Patient’s Charter, in which the pledges for patients included:
“to be guaranteed admission for treatment by a specific date, no later than two years from the day when the consultant places the patient on a waiting list”.
I might add that his Government did not achieve that. I take it that the coalition Government’s objective is not that, but the House might like to know what they think is a reasonable waiting time. We got it down to 18 weeks. What does the noble Earl think it should be?
Earl Howe
My Lords, it is right for me to make clear that the previous Government achieved a great deal in bringing down waiting times—there is no doubt that that was a major worry for patients—and they are to be commended for that. The noble Baroness is concerned that we do not let the situation slip, and I fully share that concern. As I have indicated in brief terms, two main issues will prevent it happening. The first is that the legal duty on commissioners to commission services that comply with operational standards around the 18-week referral time still applies. The second is the NHS constitution, which contains the right to access services within minimum waiting times, as she knows. Those patient rights within the constitution have not been diluted.
Baroness Pitkeathley
My Lords, the noble Earl emphasises localism in the NHS, and that is very welcome, but is he aware that patients and their organisations have expressed great anxiety about not having enough people and structures to check how their local services are doing, especially—as patients and their organisations know very well—because there are some conditions for which early diagnosis is essential if cure is to be achieved?
Earl Howe
My Lords, the noble Baroness is quite right. For example, on the waiting time targets for cancer referrals, we have made no changes because there is a clinical underpinning to those targets. She is also right to say that there is often insufficient information for patients on which to base decisions. We are very keen to build and develop information channels so that patients can be better informed and are able to make better choices about their care.
Lord Alderdice
My Lords, is my noble friend aware that one of the difficulties with targets for waiting times was that clinicians were forced to ensure that all patients fitted into the waiting times, when they were aware that some were a great deal more urgent and some not so urgent at all? Can he reassure me that in devolving more power back to clinicians and more opportunities back to local people—patients and carers—those differences between people’s requirements will be taken full account of rather than simply some artificial and arbitrary time limit?
Earl Howe
My noble friend is right because, when all is said and done, many of the centrally imposed targets were quite arbitrary. For example, why 18 weeks, not 17 or 19? It is worth saying that the targets that clinicians and managers set themselves are often a great deal more stringent than the ones that politicians are likely to set.
Lord Crisp
My Lords, as the chief executive of the NHS in England from 2000 to 2006, I think that I had better declare an interest on this matter. Although what the Government announced recently were some minor and probably quite sensible changes to targets, they also sent a big message. The message is about localness, which is very welcome, but there is also a very risky message, which is that waiting no longer matters. I know that the noble Earl understands very well that the NHS listens to what Ministers say. How will he ensure that people in the NHS understand that waiting is still a very important issue?
Earl Howe
My Lords, the noble Lord is absolutely right. I believe that the message that he wants sent has been sent by the NHS chief executive in his letter to NHS bodies. It is certainly a message that the Government want to send. Timeliness is important. A great deal has been achieved. We do not want to squander that, but we think that clinicians should now be given the responsibility to prioritise patients and treatments for themselves, not have central performance management dictated from above.
Baroness Wall of New Barnet
Does the noble Earl agree that it would be appropriate for hospitals such as Barnet and Chase Farm to carry on with our internal stretch targets, which we do not declare anywhere, but which ensure that our patients are aware that it is a good hospital to go to? They are not arbitrary—trust me, they are not; they are real—and they make a big difference.
Earl Howe
I have always drawn—and I think that my ministerial colleagues do as well—the distinction between targets that are useful for internal management purposes and for patient decision-making and targets that are micromanaged from Whitehall. There is a distinct utility in the kind of targets that the noble Baroness is talking about because, as she knows, they are often very good proxies for outcomes.