Rt Hon Lord Lilley

    Patient Choice
    3.33 pm
    Mr. Peter Lilley (Hitchin and Harpenden): I beg to move,

    That leave be given to bring in a Bill to reinstate a patient?s right to choose the hospital in which to receive treatment within the National Health Service.

    I want to restore choice not just because it is a good thing in itself and not just because patients increasingly want to exercise choice over where, when, how and by whom they are treated, but above all because choice is the dynamic force driving up improvements in quality and efficiency. In every service where the user has a choice between alternative suppliers, the less-good, lower-quality supplier has to emulate the quality of the best or lose users and revenue.
    That is why there is a continual dynamic for improvement in those services. Sadly, that dynamic no longer exists, to the extent that it ever did, within the national health service. Even though the Government are putting 30 per cent. more in real terms into the health service, it has not resulted in commensurate improvements in quality or quantity of care. Scarcely any more in-patient operations are carried out now than in 1997 and there are scarcely any shorter waiting lists now than in 1997. In addition, we have more serious problems, which are growing more rapidly, of infections and quality of care in our hospitals than on the continent.
    The Bill proposes to reinstate the right to choose the hospital in which people are treated. I say “reinstate” because the right to choose the hospital always existed within the NHS; sadly, it was unintentionally restricted by measures, including those introduced by my Government. Unforgivably, however, the last rights of choice were eliminated by circular 117, which this Government introduced in 1999. Since then, any patient must go to the hospital where their local national health service bureaucracy is committed and contracted to send them. The director of the College of Health said that as a result of that circular there is less choice in the health service now than has ever been the case in its history.
    Patients can no longer choose to go to a hospital with shorter waiting lists or waiting times. Constituents of my hon. Friend who represents the Southampton area and my hon. Friend the Member for Bexhill and Battle (Gregory Barker) have to wait 16 weeks and 24 weeks respectively for radiotherapy. They cannot choose to go to Bournemouth, where there are almost no waiting lists. Patients cannot choose to go to a hospital where there are better health outcomes. Patients in my constituency are contracted to be sent to a hospital that had the worst outcomes for hip operations. One in six of those treated for an emergency hip operation died within 30 days of the operation and could not choose to go elsewhere.
    It is not possible for a patient to choose to go to a hospital that he believes is cleaner or has fewer cases of methicillin-resistant Staphylococcus aureus?MRSA?infection. Sadly, the sixth-worst hospital for that is near my constituency. Patients cannot choose to go to a hospital near their relatives, even if it treated them when they lived in the area, or to a hospital with single-sex wards.
    The Bill would repeal that circular and restore the right of patients to choose which NHS hospital they attend. Patients need more than that, however. They need information, especially on waiting lists, so that they can make informed choices. That information is collected by the College of Health on the national waiting list helpline, but the Government refuse to publish it. I agree with the right hon. Member for Birkenhead (Mr. Field) that it should be published and available in every hospital waiting room and on a website, which he categorises as easyop.com.
    Information about health outcomes should be available, preferably on the basis of the pre-operative condition of the patient. We should allow for that variable, as they do in the United States, so that people can assess the success rate of different hospitals and different surgeons. Information about infection rates should be more readily available. Although that is now being made available, until recently my health service did not discuss or report it at its management meetings.
    We also need a diversity of suppliers. We need genuinely independent trusts that are not micromanaged centrally with the objective of uniformity. We also need other not-for-profit hospitals, such as charitable hospitals, and new enterprises, although they would need to meet the cost levels set by the NHS. Above all, taxpayers? money must follow patient choice. That empowers choice by rewarding and reimbursing hospitals that treat patients and ensures that the successful and popular hospitals do not run through their budgets before the end of the financial year and have to close, as was the case.
    I congratulate my right hon. Friend the Leader of the Conservative party on sending the health team to other countries to see their successful health services. I am sure that the common feature that they will have discovered is that patients have choice; they have the knowledge to make an informed choice; there is diversity of supply; and patients? money, the taxpayers? money, follows their choice.
    When I published these ideas some while ago in an excellent booklet, available from my website for free or from Demos for ?6.95, the Government ridiculed them and said that if patients were given back choice, they would be racing up and down the country looking for better hospitals or shorter waiting lists. Now, of course, the Government are sending patients racing around the Mediterranean looking for the same things.
    The Government published a White Paper on involving patients in health care, which spoke of committees and consultation but did not even mention the word “choice” or the idea of giving choice to patients. Now, belatedly, the Government are trying to adopt the rhetoric of choice. I would welcome that if it involved any substantial change, but so far they have simply said that if people are still alive after they have been on the waiting list for a heart operation for six months, they will be allowed to choose another hospital that can do the operation more quickly than the one whose waiting list they are on.
    The Government have created a massive new bureaucracy to supervise that. A whole new tier of officials will mediate between a patient?s GP and consultant and then talk to the patient to decide whether he or she is suitable to be given choice and, if so, where and how it can be exercised. The individual and his or her GP no longer make that choice.
    My Bill will restore choice and give patients the information to make an informed choice. There will be diversity from which they can make their choice, and taxpayers? money will follow patients? choice. Choice is not a panacea; on its own it is not a sufficient remedy, but it is essential if we are to have a reformed health service that takes advantage of the extra resources available to it by improved quality of care. I commend my Bill to the House.
    Question put and agreed to.
    Bill ordered to be brought in by Mr. Peter Lilley, Sir Patrick Cormack, Mr. Frank Field, Alistair Burt, Mr. Christopher Chope, Mr. Michael Portillo, Mr. Andrew Tyrie, Mr. Gregory Barker, Mr. David Cameron, Mr. George Osborne, Mr. Mark Prisk and Mr. Andrew Turner.
    31 October 02 c872-4