Health Bill [Lords]

The Secretary of State appears not to have remembered some of our exchanges, because I have been very clear about the matter: I would remove a central, top-down, four-hour process target. Commissioners and providers of service in the national health service need to arrive at a contract that makes clear the standards that they will meet. In emergency care and other aspects of care, however, the Government's objective should be to move from targets to outcomes. He might like—[Interruption.] I shall explain the issue to the right hon. Gentleman, because, since he became Secretary of State, he will not have had the opportunity to read the latest—further—report by Dr. David Colin-Thomé, the national clinical director for primary care, on what has happened at Staffordshire general hospital. He makes clear both the distinction between targets and outcomes and his belief that the Government's and Department's responsibility should be to focus on those outcomes. The job from the centre is to specify the outcomes that we are trying to achieve, so, for example, emergency admissions for stroke might indeed embrace 30-day mortality. The quality of subsequent stroke care might include the proportion of patients who go on to live independently, and we can benchmark that against performance in other countries and determine, as we should, the quality of care in this country as compared with other countries. We cannot compare the four-hour target to other countries, however, because they do not define the quality of care that is provided by simply measuring how long people wait in an emergency department. Processes, including the standards that support outcomes, must be determined between those who purchase services on behalf of patients and those who provide them. That might well include a question about the length of time that patients wait, but it would be negotiated and exist in a culture of continuous improvement. Some places would say "not 98 per cent. but less than 98 per cent." Others would say, "more than 98 per cent." If the Secretary of State talks to people in emergency departments, he will know that they might say, "Actually, we should have quite a different time in emergency departments for those who present with minor conditions as compared with major conditions." In a contract with a hospital, one might quite properly have specified standards that set a much shorter waiting time for children than for adults.