The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move,
That this House has considered the matter of the Francis Report: One year on.
A year on from the Francis report, let us remember that we stand here today thanks to the courage of a few lonely voices who fought against the odds to be heard as they campaigned against appalling neglect and abuse at the heart of our national health service. They had a truth to be told, they refused to be ignored, they stood up to a mighty system, and when they were turned away by regulators, NHS leaders and Ministers, they just came back speaking even louder—people such as Julie Bailey and Helene Donnelly, both of whom received honours this year, and thousands more who wrote and campaigned for loved ones, not because they wanted a penny of compensation but because they wanted to prevent this tragedy from ever happening again.
The last Government repeatedly refused to set up a public inquiry into what happened at Mid Staffordshire NHS Foundation Trust, but to his enormous credit, my predecessor overturned that decision, with the honourable support of a number of Staffordshire Members. As a result, the voices of their constituents were finally heard, and hard truths were told.
Today, the whole House will want to thank Robert Francis QC and his inquiry team for the thorough and thoughtful job that they carried out. Their remarkable report demanded a monumental response, and I sincerely hope that that is what the coalition Government have delivered. The Care Quality Commission, once ridiculed, is now trusted, with a record number of calls to its whistleblowing helpline. Failing hospitals are being turned around, with stronger leadership and improved staffing levels: there are 3,500 more nurses on our hospital wards since the Francis report, more than 80% of hospitals have taken new action in response to the report, and confidence among NHS staff that their organisation has the right priorities has risen. Of course, there are many more things to do, but it is clear that something profound has changed in the culture of the NHS.
Mr John Redwood (Wokingham) (Con)
I admire what my right hon. Friend is doing to get a new culture of honesty in the NHS. Does he think that all the major hospitals in the country now automatically report problems and mistakes, so that they can be investigated and remedied?
Mr Hunt
The truth is that the process takes time, and there are still examples of where candour is lacking. Allegations have recently surfaced in the press, the substance of which makes it appear that that reporting has not happened. There is much work to do, but the signal has gone out loud and clear that if people are open, transparent and honest from the start when something goes wrong, that should not be punished but should be recognised as a way of improving how we look after patients, in the same way as profound changes in the airline industry have made our aeroplanes much safer. We need that change in the NHS.
We also now recognise that however important ministerial objectives and national targets may be, NHS organisations should never prioritise them at the expense of dignity and respect for patients. We now know that the best way to deal with poor care is for people to speak out about it, whether they are a health care assistant, doctor, nurse or even Secretary of State, and that that should never be confused with “running down the NHS”. We also know that failing to speak out about poor care, or to support those who do, is a betrayal not just of patients but of the kindness and humanity of more than 1 million dedicated NHS staff, thousands of whom pledged themselves to compassionate care just two days ago on NHS change day.
What has happened in the past year? Robert Francis asked why the system effectively failed to detect or deal with the problems at Mid Staffs for a shocking total of four years. We have re-established the CQC as a rigorous and independent inspectorate, with three powerful new chief inspectors appointed to speak truth to power. The Keogh review inspected 14 hospitals last summer, and the new chief inspector of hospitals, Professor Sir Mike Richards, has already completed inspections of a further 18 trusts, with 19 more inspections taking place now. As a direct result, 14 trusts are now in special measures—a record in NHS history—and, thankfully, long-standing problems are finally being tackled.
On staffing, the inquiry found
“an unacceptable delay in addressing the issue of shortage of skilled nursing staff.”
The latest figures show that not only are there 3,500 more nurses on our hospital wards since the Francis report, in just a year, but we now have more nurses, midwives and health visitors in the NHS than ever in its history. From this summer, all hospitals will publish their staffing levels monthly, on a ward by ward basis, so that shortfalls are speedily identified.
Robert Francis identified a closed, defensive and secretive culture at Mid Staffs. In response, we have ended gagging clauses and we are making it a criminal offence for trusts to publish or provide specified information that is false or misleading. We are also placing a statutory duty of candour on organisations so that they are required to be honest with patients about poor care, and professional regulators are consulting on a new professional duty of candour that provides protection for staff against being struck off if they are open about the problems they see. I believe that will create one of the most transparent and open health care systems in the world.
Andrew George (St Ives) (LD)
I welcome the important steps in the right direction that have been taken with regard to recording and safe staffing on acute hospital wards. The Secretary of State also announced last year that he intended to introduce a system whereby nurse trainees would shadow or work alongside care assistants for up to a year. Is that idea being developed at the moment?
George Freeman (Mid Norfolk) (Con)
Does the Secretary of State agree that it is important to remember that part of what allowed the Francis report was the release of data on outcomes, and that such data transparency is crucial to understanding where best and worst practice exists, which may not otherwise be picked up?
Mr Hunt
My hon. Friend is, as ever, absolutely right on this issue, which he has spoken about a great deal. The use of data allows inspections to be meaningful in a way that has not been possible before. We have to ensure that the public are happy that protections are in place on how their data are used, but at the same time we must be bold in using those data, because that saves a lot of lives.
The inquiry condemned the way in which complaints were handled in Mid Staffs. Following the excellent work carried out by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart, all hospitals will now have to demonstrate to inspectors that they treat complaints as more than just a process and are actively using them to learn and improve.
Doctors have responded to the new climate of transparency by agreeing to a world first: to make England the first country anywhere that publishes surgery outcomes by consultant for 10 major specialties. More specialties will follow.
Chris Bryant (Rhondda) (Lab)
This point does not quite follow on from what the Secretary of State is saying, but I spent all day yesterday with rugby players and neuropathologists talking about chronic traumatic encephalopathy, which often follows rugby injuries. One big difficulty is that concussion is regularly misdiagnosed, or completely and utterly missed, throughout the whole NHS, and that sports bodies are not taking the matter seriously. Will he seriously consider changing the whole way in which the NHS engages with sports and with that issue?
Mr Hunt
As the hon. Gentleman knows, I used to be responsible for sport in this country, so I take a great deal of interest in the issue. I will certainly consider his point. We all remember what happened to Fabrice Muamba, and sport has a role to play in raising awareness of conditions that people might not otherwise be aware of.
Mr Mark Harper (Forest of Dean) (Con)
From listening carefully to my right hon. Friend’s remarks, I noticed that he referred to England. I am not sure that all the lessons from the Francis report have necessarily gone across the border to Wales. That concerns me, because thousands of my constituents are forced to use the NHS in Wales—although their GP is in England, they are registered with the NHS in Wales. Can my right hon. Friend say anything to reassure my constituents that they will soon be entitled to treatment in England, as is their legal right?
Mr Hunt
I am concerned about that on a number of levels, but I can reassure my hon. Friend that I have taken on board that point, which he has raised with me privately, and I will look into it. I have asked for a solution to be found soon, and certainly before the end of the year, so that his constituents can have that long-standing problem addressed.
Nurses, who were mentioned by the hon. Member for St Ives (Andrew George), have also embraced reform. The inquiry was clear that
“practical hands-on training and experience should be a pre-requisite to entry into the nursing profession”.
We now have 165 nurse trainees spending up to a year as health care assistants before starting a degree—a pilot that will inform how we roll out the programme nationally. The inquiry said the public should always be confident that health care assistants have had the training they need to provide safe care, and on the advice of Camilla Cavendish our new care certificate will provide assurance that health care assistants and social care support workers receive the high-quality, consistent training they need to do their jobs and deliver compassionate care.
Robert Francis also identified particular problems with the leadership of Mid Staffordshire Trust. We have many outstanding leaders in the NHS, but not enough, so we have set up a 50-place fast-track executive programme to attract clinicians and talented outsiders into NHS management, and we have already had more than 1,600 applicants. We are also introducing a new fit and proper persons test for board-level appointments, to help ensure that people with poor track records cannot resurface elsewhere.
The inquiry also heavily criticised my Department for being
“too remote from the reality of the service they oversee”.
We have introduced a new programme, “Connecting”, under which civil servants will spend four weeks every year on the front line. In the past year, Ministers, including me, and senior officials have spent more than 1,300 days working on the front line, leading to what I believe is a real and profound change in the way we approach our work and ensure good advice is provided to Ministers. Those changes have seen a welcome increase in the number of staff who feel that care of patients is the main priority for their organisation, according to the latest NHS staff survey.
If the NHS has listened, so too must we in this House. As constituency MPs, many of us, including me, have championed our local hospitals, sometimes unquestioningly, and sometimes without sufficient regard for the quality of care provided. Too often we have accepted the convenient explanation that individual cases of poor care were the exception, when in our hearts we knew the problem was more widespread. We must be champions for change in our communities, just as the Mid Staffs campaigners were champions for change in theirs.
Nowhere is that more true than in Wales. Although health is a devolved issue, unfortunately failures in care in Wales are now having a direct impact on NHS services in England, with a 10% rise since 2010 in the number of Welsh patients using English A and E departments, leading to very real additional pressure on border town hospitals. What is causing that pressure? Dr Dai Samuel of the Welsh BMA describes standards of care in Wales as follows:
“It’s pretty horrific...the level of care being given to patients is compromised...substandard we are seeing a miniature Mid Staffs every day.”
NHS England medical director professor, Sir Bruce Keogh, and president of the Royal College of Surgeons, Professor Norman Williams, have written to the Welsh authorities calling for action, only to be completely ignored. Professor Williams said that
“an analysis of NHS data in the region has highlighted the fact that the waiting lists for elective cardiac surgery in South Wales are higher than is clinically appropriate... Expert reports suggest that 152 patients have died in the past 5 years while on the waiting lists”.
If that creates pressure in England, it is a tragedy for Wales, yet still the authorities there continue to act as if the lessons of Mid Staffs stop at the border. If the Labour party, which runs the NHS in Wales, will not listen to the Government about this, it should please listen to its own Back-Bencher, the remarkable right hon. Member for Cynon Valley, who, following her own terrible family experience, has campaigned tirelessly to improve standards of care in Wales, particularly with respect to mortality rates at six Welsh hospitals. If there is one outcome from today’s debate, let it be not simply an examination of data methodology in Wales, but a proper, independent examination of mortality rates, allowing UK-wide comparisons. Given the implications for the English NHS, we need leadership from Labour Front Benchers in this place to encourage their Welsh colleagues to do what is right to save lives in Wales, as well as to reduce pressure on the NHS in England.
That highlights a broader, more uncomfortable issue for the House. Clear policy mistakes lay at the heart of why Mid Staffs was ever allowed to happen, but while no one is questioning the integrity or good intentions of Ministers in that period, those mistakes have never been acknowledged by the Labour party, even though the entire tragedy happened on its watch. Labour continues to make a political issue of which party can be “trusted” with the NHS, but cannot see that the refusal—[Interruption.] This is uncomfortable for Labour Members to hear, but lives were lost and I suggest they listen. Refusing to learn the lessons of Mid Staffs is the surest way to persuade the public that Labour does not merit that trust.
Do Labour Members now accept that the Government were right to hold a public inquiry into Mid Staffs, contrary to their wishes, given the many important changes that have come about as a result? Do they accept that Mid Staffs was not just about bad individuals, but about a corporate obsession with system targets that led to poor and unsafe care, and that we must not allow that to happen again? Do they accept that the Government were right to restore expert-led inspections that Labour got rid of 2008, and will they now undertake to support the new chief inspectors in their much more rigorous inspections? Do Labour Members accept that Ministers should never—as was alleged to have happened before—put pressure on regulators to tone down news about poor care? Do they support the statutory independence that we have now granted the CQC? Do they accept that we should never push hospitals to foundation trust status so quickly that they neglect patient care? Finally, and most important, do they accept that exposing and being honest about poor care is not about running down the NHS but is about protecting it and standing up for patients? I hope that when the right hon. Member for Leigh (Andy Burnham) responds he will be able to answer those questions and put to rest the concerns of relatives and survivors of Mid Staffs about his approach to date.
Mr William Cash (Stone) (Con)
May I reiterate what my right hon. Friend has said about the absolute point-blank refusal, repeatedly and whenever I raised the question of an inquiry under the Inquiries Act 2005, to hold such an inquiry? The previous Government would not hold an inquiry; they totally refused to do so, which was an absolute disgrace. To his credit, the present Prime Minister listened to my arguments, and one of the first things he did when he came to government was set up an inquiry, which now has the capacity to transform the national health service.
Mr Hunt
We are about to hear from the shadow Health Secretary who will have the chance to put things right on that account. My hon. Friend the Member for Stone (Mr Cash) was extremely courageous, determined and persistent in campaigning for a public inquiry, and with the support of my predecessor and the Prime Minister, that is leading to the profound changes we are seeing today. We would all welcome the Labour party’s support for that.
I opened this debate by paying tribute to a few brave individuals who started a movement in England for safe, effective and compassionate care.
Mr Hunt
No, I am about to conclude. This afternoon it falls to this House of Commons to stand four-square behind that movement, so that one year of the Francis report becomes a lifetime of change for the NHS. We all want to say two words, “Never again,” but those words derive their conviction from what we do as well as what we say. However contrite we feel now, we should always remember that good people with good intentions stood at this Dispatch Box, and still an unspeakable tragedy was allowed to happen. We cannot rewrite history but we can, and must, learn from it.
Andy Burnham (Leigh) (Lab)
This debate is a welcome opportunity to review progress on the Francis report one year after its publication. That publication completed a long process of independent inquiry into the terrible failings at Stafford hospital, and it began in July 2009 with my appointment of Robert Francis, QC. Ever since, the onus has been on us all to learn the important lessons and implement all the recommendations of the Francis report.
First, however, I will say a word about the previous Government’s record. It was the previous Labour Government who introduced for the first time independent regulation to the national health service, following the scandals of the 1990s at Bristol Royal infirmary, Alder Hey and, of course, the Shipman murders. It was that independent regulator which uncovered the problems at Mid Staffs. To listen to the Secretary of State, one would not believe that those were the facts—
Andy Burnham
I want to make some points at the beginning and then I will give way to the Secretary of State.
Those were the actions of the last Government in dealing with the issues that we inherited. It was the last Government who left the national health service with the lowest ever waiting lists and the highest ever public satisfaction, and no attempt by the Conservatives to rewrite history can take away that fundamental strength in the NHS which the last Government left behind.
Mr Hunt
I agree with the right hon. Gentleman that his predecessors deserve credit for introducing an inspection regime into the NHS, but would he now agree that it was a big mistake to allow expert-led inspections—the kind of really thorough inspections that could have uncovered what happened at Mid Staffs—to be abolished in favour of generalist inspections, which meant that the same people inspected dental clinics, GP practices and big London teaching hospitals? That was a profoundly important mistake that this Government are right to correct.
Andy Burnham
It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.
We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.
Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out.
Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS. If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.
To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.
Andy Burnham
In a moment.
On all measures, this winter has been just as bad as the last, with some patients waiting hours on trolleys, or held at the door of A and E or in the back of ambulances. A and E is the barometer of the whole health and care system, and that barometer is warning of severe storms ahead.
Mr Jeremy Hunt
As it happens, waiting times for A and E departments are now half what they were when the right hon. Gentleman was Health Secretary, but may I gently suggest that rather than trying to turn this debate into a discussion about who had the better A and E performance, he should return to the Francis report, which is what the debate is about and which deals with something that happened on his watch? The country wants to know what his party, and he personally, have learned from the mistakes that were made that allowed Mid Staffs to happen.
Andy Burnham
Pressure on hospitals, and how we relieve it so that they can care for people properly, is the core of this debate. What we have seen under this Government is an ever-increasing number of frail, elderly people coming into hospital via A and E. The Secretary of State shakes his head, but Francis made specific recommendations on the care of older people in hospital. The point I am making is that under him the number of older people admitted to hospitals as emergency admissions has gone up significantly, and that goes to the heart of the issues raised by the Francis report.
Paul Burstow
I am grateful to the Minister for correcting the record from a sedentary position.
There were 350 children on adult wards in 2013-14, including one as young as 12, and the use of restraint has been at a high level. I know that the Minister for care services is championing changes in that area. I very much welcome his leadership on the crisis care concordat. It is very important that the CQC leads on regulation to show that it is not just words, but will be backed by regulatory teeth.
The culture change also needs to be about listening to patients. The evidence again suggests that there is still a long way to go. The Care Quality Commission has found that a quarter of care plans showed no evidence of patient involvement. That cannot be right, whether for a long-term physical health condition or a mental health problem.
We have only just had a tariff for mental health. When I arrived as a Minister with responsibility for it, I found that the task of producing tariffs had already taken five years, having dragged on and on. Yet because of the difference in how we funded mental health services, it was easier to cut them in the past. The picture of spending on mental health is rather more nuanced than it is sometimes portrayed in debates in this place.
Given all that, we might have expected NHS England to ensure that its response to the Francis inquiry and to the Government response recognised that poor care can occur in mental health as well. The chair of NHS England, Malcolm Grant, has put his name to the statement of common purpose that prefaces the Government response to Francis. Yet NHS England has ignored this Government’s mandate to it to deliver parity of esteem. NHS England’s financial experts do not get it: they are delivering Francis’s agenda simply for the acute sector, and taking money away from mental health services through adjustments to how payments are made for them. That cannot be right. I know that the Minister agrees with me, but doing so is not sufficient: there must be a challenge to NHS England’s decision to take away money from mental health, given that both sectors need to make progress and to take steps to deal with the Francis agenda.
Norman Lamb
I just want to alert my right hon. Friend to the fact that David Nicholson, the chief executive of NHS England, has made it clear to area teams and therefore to clinical commissioning groups that they must take parity of esteem fully into account in financial settlements with mental health trusts. That clarification of the importance of parity of esteem on finances is critical, and I hope that he welcomes it.
Paul Burstow
I very much welcome that and what the Minister says.
The reason I have raised issues about mental health in this debate is that it would be a mistake for Members to see Francis simply through the lens of acute hospital care. As the Government said in their response to Francis, we need to be concerned right across the piece. That is why I make no apology for focusing my speech on mental health, and why I hope that the Government will continue to drive an agenda of parity of esteem and make it a reality.
Mr William Cash (Stone) (Con)
It is quite difficult at this stage in the saga—the tragedy—of Stafford hospital to recall how it all came about and the difficulties that those of us who experienced it had to endure, the patients and the victims in particular. There was complete and total resistance—indeed, worse than that, a granite-like refusal—to having a proper look at what was going on. It would take much longer than I have available this afternoon to explain exactly the tooth and nail battle that I had to engage in to get the inquiry in the first place under the Inquiries Act 2005.
In a previous incarnation as the Member for Stafford, I had already had Stafford hospital in my constituency for 14 years, from the date of a by-election some 30 years ago in May 1984. I experienced a tragedy in Stafford hospital during that time with legionnaire’s disease, and I came to this House and asked the then Prime Minister, the late Margaret Thatcher, whether she would give us a full public inquiry—equivalent to one under the provisions of the 2005 Act. I did that because I knew it was impossible to get to the root of what was going on unless we had such forensic evidence, with cross-examination on oath and all the other—not paraphernalia, but necessary ingredients as part of the process, to ensure that we could bring to light what was required.
I was absolutely astonished that successive Secretaries of State completely refused, point-blank, to have such an inquiry in the case of Mid Staffordshire. I have to put it on record that the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who is not even in the House this afternoon—perhaps he has some excuse or justification—was the Secretary of State during a lot of the time in question. Patricia Hewitt was also Secretary of State for part of the time when serious problems were going on. The right hon. Member for Kingston upon Hull West and Hessle refused to have a public inquiry. The right hon. Member for Leigh (Andy Burnham) also refused to have an inquiry of the 2005 Act type. Although it is certainly true that he agreed to a Francis inquiry, and that there was also the Alberti report, the Colin-Thomé report and one or two other investigative exercises, none of them had the right ingredients to give them the capacity to get to the root of what was going on.
I am delighted with what my right hon. Friend the Secretary of State has done since then. I was extremely glad that, when we were in opposition, I was able to overcome some resistance to a 2005 Act inquiry from shadow Ministers. The current Prime Minister, then the Leader of the Opposition, listened to the arguments that I and others made and agreed to have a full 2005 Act inquiry, because he understood how important it was, as the Secretary of State does. The consequence has been to enable us to make changes throughout the entire health service that, as Opposition Members have acknowledged today, have enabled us in Staffordshire to be a pathfinder for solving some, if not all, of the problems presented in the health service.
The work of Cure the NHS has included that of my constituent Deborah Hazeldine. She does not get a great deal of publicity, but she was the one who came to me in my office in December 2008, with Julie Bailey, and explained that they were getting nowhere with the complaints and concerns that they were expressing. They asked what could be done about it, and I explained to them that if they did certain things, I thought we would be able to get a campaign moving of the kind that would be needed to get a 2005 Act inquiry. I pay tribute to them, and to Ken Lownds, who has been a tower of strength. He is a man of enormous integrity, knowledge, skill and commitment. I pay tribute to him for what he did to ensure that we got the inquiry, for the evidence that he gave to it and for his continual determined input into improving the health service since the Francis report was produced.
I am delighted that the Francis report came out as it did. It had, I believe, 299 recommendations, and it has been immensely important to the future of the health service. I do not need to go into all the details, but I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my next-door neighbour, with whom I worked closely from the beginning. He committed himself to a 2005 Act inquiry when he was in what could be described as the delicate situation of being about to become the Member of Parliament for Stafford but not entirely certain that it would happen. He did it, and he was right, and I pay tribute to him for everything that he has done since.
Mr Jeremy Hunt
I am grateful to my hon. Friend for his generous comments. While he is paying tribute to people who have played an important role in getting us to where we are, may I add my thanks to Deborah Hazeldine, and also to Ken Lownds, who was the first person who really talked to me about the important concept of zero-harm health care? I know my hon. Friend will not mind if I also mention campaigners from other hospitals, such as James Titcombe in the case of Morecambe Bay, who have also played an extremely important role in the debate.
Mr Cash
I am extremely glad that my right hon. Friend has made that point. The zero-harm policy is so important, and I am grateful for that specific intervention. It will make Ken Lownds’s day. I also pay tribute to people all over the country who have taken up the message and sought to improve the health service in their areas. This has turned into a national campaign, and the Secretary of State deserves great credit for the way he has helped to co-ordinate it.
I was, and remain, completely amazed that the right hon. Member for Kingston upon Hull West and Hessle, and Patricia Hewitt, were not even asked to give evidence to the inquiry. I still find that completely staggering to my way of thinking. I know that the right hon. Member for Leigh was asked to give evidence, and did, but I place the point on the record because I found it extraordinarily difficult to understand then, and I still do now.
I have constantly and repeatedly called for the resignation of Sir David Nicholson. I know he is retiring soon and that that resignation will not happen, but I repeat my concern, as I did in evidence to the inquiry, because the whole target-based policy was very much tied up with his approach to these matters. Indeed, in the last of, I think, about 600 paragraphs of his evidence to the inquiry, he referred in the last two lines to the fact that the Member of Parliament for Stone, Mr Bill Cash, had raised the question of his involvement in target-based policies. He said that there were arguments on both sides of the equation regarding target-based policies, but I do not agree with that. I do not think target-based policies were the right way to go, and I am glad that the hon. Member for Stoke-on-Trent North (Joan Walley) agreed with me. As I pointed out in my evidence to the inquiry, such policies had a terrible effect on the attitude of Monitor regarding the financing issues that provided 39 of the 45 or so questions put by William Moyes to the foundation trust when it received its approbation—something it should never, ever, have got. I say to the right hon. Member for Leigh that through the mechanism of the Department—I cannot point precisely to chapter and verse—the fact that the foundation trust got such status was also the product of a misjudgment by the Government at the time.
I have already referred to correspondence in an intervention, but in the prime ministerial guidelines of 2005, under the previous Government, it was clearly stated that when Members of Parliament write to Secretaries of State and other senior Ministers, they are entitled to receive a full, comprehensive response—personally—from that Minister. I found that wanting during this process. I was glad to note, however, that in the course of evidence to the inquiry, the situation moved from what appeared to be resistance to going down that route, to an acceptance that—to paraphrase from the evidence given by the chief executive of the Department of Health—from now on, when a Member of Parliament writes with a letter from a constituent, and explains that things have not gone properly regarding that constituent’s health problems, there is a mechanism to ensure that the issue is dealt with properly. I will not have to go into all that today, because it has been rectified.
In my evidence, I also raised the issue of whistleblowing. I also tabled amendments to the then health legislation, calling for the repudiation of gagging clauses and providing that any chief executive who endorsed them and got his legal advisers to agree to them should be dismissed. That is another area that has been dealt with, so we are making progress. I very much endorse the views expressed on both sides of the House about having unity across the Floor of the House, as far as we can achieve it, on the central principles.
I agree with what my hon. Friend the Member for Stafford said about the issue, although I have a difference, not of opinion but of emphasis, because my constituency is very rural, and access to the artery of the M6 is not easy. It can be difficult to reach, especially at night, because it can be a long way through small rural lanes, to access the M6 and the University hospital of North Staffordshire or hospitals in Wolverhampton. That is my caveat on that.
We have made enormous progress. I am glad that the Mid Staffs foundation trust is being dissolved, and that—as my hon. Friend the Member for Stafford said—the Prime Minister, at a recent Prime Minister’s questions, backed plans, in as many words, for consultant-led maternity to continue at Stafford hospitals. That service, plus paediatric services, critical care and a 24-hour emergency service, is necessary for constituents in Stone and the rest of Staffordshire. I will work with my hon. Friend to ensure that that is delivered.
Barbara Keeley
Indeed, and our most recent inquiries in the Health Committee are about mental health issues. There is a series of issues that need to be looked at. It is rare in a health debate for me not to mention carers. We need to be realistic about the fact that we are now putting a huge amount of pressure on those carers. Removing social care packages will affect our local hospital, but it will also affect those family members, because in the end who is the person who cares? It is the family member to whom the role falls.
To conclude the point about staffing issues in A and E, we found in our earlier inquiry that fewer than one in five emergency departments were able to provide consultant cover for 16 hours a day during the working week, and the figure is lower at weekends. The whole issue of mortality rates is very much linked to that, and we cannot ignore it. We must keep focusing on the problem with recruitment and the lack of consultant cover.
My right hon. Friend the shadow Health Secretary referred to the warnings by the president of the College of Emergency Medicine. During the time when the college was warning about these issues, Ministers were tied up in knots by the challenges of reorganisation. That is key. Ministers have insisted that they are acting now, but it is clear that those warnings from the CEM in 2010 did not get enough attention until recently. The staffing situation can hardly improve when so few higher trainee posts in emergency medicine are being filled. In the latest recruitment round, 156 out of 193 higher trainee emergency medicine posts went unfilled.
My final point is about the difficulties caused by the cost of the NHS reorganisation reforms. In the past few months the spotlight has fallen on unnecessary spending and waste. We all should be concerned about that. We know that emergency departments are spending £120 million a year on locums, and this could be getting worse. The Health Committee has also recently focused on redundancy costs, which have absorbed £1.4 billion of NHS funding since 2010, with £435 million attributed just to restructuring costs. The scandal of the scale of redundancy payments to NHS staff was made worse when we found out that such a revolving door was in operation. The Health Committee was told that of 19,100 people made redundant by the NHS, 3,200 were subsequently rehired by the NHS, including 2,500 rehired within a year and more than 400 rehired within 28 days. There were reports of payments of £605,000 made to an NHS executive whose husband also received a £345,000 pay-off, with both reported to have been subsequently rehired elsewhere in the NHS. That is a scandal. I know that the Minister said it would not happen again, but that is £1 million that could have been spent on patient care.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Will the hon. Lady give way?
Barbara Keeley
I would prefer not to. That money could and should have been spent on improving staffing, particularly nursing staffing. Those patients and family members who have been let down by NHS failures, of which we have heard innumerable examples, deserve to know that everything possible is being done to avoid such failures in future.
Of all the things I have talked about, safe staffing is crucial, as is transparency and staffing ratios. We increasingly have to take on board the fact that there is a funding gap in both the NHS and social care. Indeed, the chair of the British Medical Association said in his new year statement that the funding gap in the NHS is so bad that if the NHS was a country, it would not have even have a credit rating. That is what we are facing.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The publication of the Francis report was an incredibly humbling day for our national health service. It was humbling not just for those of us in this place who care about our NHS, but for the many staff who work tirelessly to look after patients and for everybody involved in looking after people as part of our health and care system.
The central plank of the report highlighted the fact that a culture had developed at Mid Staffordshire that was not in the best interests of patients. Targets and bureaucracy had got in the way of delivering high-quality care, and far too often the management of the trust did not listen to the concerns of patients or to the sometimes valid concerns of front-line members of staff.
Robert Francis made a number of recommendations in his report. The Government accepted the principles of the report and we have made great progress in implementing many of the proposals, which I will come on to later.
It is important that all parts of our health and care system learn lessons from things that have gone wrong in our health service. Front-line staff need to learn lessons where appropriate and managers need to learn to listen and respond to the concerns of front-line staff. We need to create a culture that is open and learn how to put things right in the future in order to improve patient care. That is what good health care is about, whether someone works on the front line of the service or whether they are involved as a commissioner, a manager or a Minister.
There have been many good contributions to the debate and I will do my best to touch on as many of them as I can in the time available. In particular, there has been strong advocacy for the local NHS. I pay particular tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy) for his work and tireless advocacy over many years—including before he became an MP and certainly during his time in this place—on behalf of his local patients and the local hospital and staff who look after them in Mid Staffordshire. Without his long-standing efforts and those of my hon. Friend the Member for Stone (Mr Cash), we would not be where we are today and that part of the world would be less better represented. Importantly, they are the people who have asked consistently the difficult questions and allowed us to get to our current position of not just tackling poor care at Mid Staffordshire and putting right the challenges that that has thrown up, but looking at how we can improve pockets of bad care elsewhere in our health and care system.
Most hon. Members have focused on two particular themes, the first of which is the need to learn lessons from the Francis inquiry into what happened at Mid Staffs, for the benefit of the wider health and care system. We heard some very good speeches, particularly from the right hon. Member for Rother Valley (Kevin Barron), my right hon. Friend the Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worthing West (Sir Peter Bottomley). They discussed the broader lessons that can be learned and the importance of an open culture, of supporting clinical leadership and of recognising that perhaps staff are the best advocates of what good-quality patient care looks like in our health system.
In his constructive contribution, my hon. Friend the Member for Cannock Chase (Mr Burley) noted that the challenges and difficulties faced in Mid Staffordshire arose because the management in particular were blinded by targets, financial incentives and drivers, and lost sight completely of what matters most in a hospital at all times, which is delivering high-quality, good patient care. The biggest lesson we can learn, as my hon. Friend made clear, is that we need always to make sure that the delivery of high-quality care is the first and only driver of what happens on the ward. It should never be about meeting a financial target. Of course, the two are not always mutually exclusive, but in this case it is very clear that things went very badly wrong at that trust.
As was pointed out by the shadow Minister, the hon. Member for Leicester West (Liz Kendall), a significant speech was made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who talked about the importance of parity of esteem between mental health and physical health. He did a lot in his time in government, and he has always been a keen advocate of that. I know that he is very proud, as the Government are, that the 2012 Act has for the first time enshrined in law genuine parity of esteem between physical health and mental health. That was touched on by the Francis report, and the Government can be proud of doing that. As he will know, we have also invested £450 million in improving access to treatment in mental health services. I know that he took that forward in government, and he can be very proud of that record.
Paul Burstow
Through the Minister, may I pose a question to my hon. Friend the Minister of State who has responsibility for care services? He told us that Sir David Nicholson had issued a clarification about area teams not doing enough to deliver parity of esteem, but that has not materially changed how the finances are arranged, with money being taken away from mental health to pay for Francis delivery in acute care. Will that be addressed?
Dr Poulter
My right hon. Friend is absolutely right to say that the first step in addressing financial disincentives for mental health, which have been in the system for many years—in fact, for decades—was to establish parity of esteem in law. He helped to achieve what for the first time has been done under this Government. The next step is of course to make sure that other measures are in place to encourage and incentivise the system to spend money appropriately. Members on both sides of the House agree that we should take pressure off acute services, and nowhere is that more important than in mental health. It is important to invest in improving access to psychological therapies and talking therapies to support people, and to put in place early intervention for those with mental health problems. That is quite important, so the Government are investing money in it.
It is also important to collect proper data on mental health for the first time. For many years, data have not been collected effectively to ensure that we know what good mental services look like, but the Government will make sure that we can deliver that.
Andy Burnham
I thoroughly agree with the Minister about collecting data on mental health so that we can make proper judgments about the quality of services, but why has the Department of Health scrapped the annual survey of expenditure on adult mental health services?
Dr Poulter
It is very difficult for me to stand at the Dispatch Box and take any lessons from the right hon. Gentleman and the previous Government on mental health issues. Only this Government have taken serious steps to improve parity of esteem and enshrine it in law, and only this Government are investing in mental health on the ground, with £450 million that is particularly focused on talking therapies. If the previous Government had any interest in mental health, they had 13 years to make investments and to improve data collection to drive better commissioning, but they took no steps towards doing that, and I am afraid that their record on mental health was abysmal and very poor. Unfortunately, patients paid the price for that.
We are very proud of our record on mental health, but it will take several years to turn around the fact that there was no parity of esteem in the past. Investment is now going in on the ground and things are being put in better order. My right hon. Friend the Member for Sutton and Cheam played his part in that, and the 2012 Act was a huge step forward in delivering those improvements.
I will try not to get drawn away from the topic of the Francis inquiry, Mr Deputy Speaker—we are talking about the broader health and care service—but I mentioned mental health, which we can be proud of, because it was mentioned by Francis in his report.
It is also important to talk about some of the wider lessons that can be drawn from the Francis inquiry. The right hon. Member for Cynon Valley (Ann Clwyd) and my hon. Friend the Member for Vale of Glamorgan (Alun Cairns) spoke particularly about the need, apolitically, to make sure that the whole of the United Kingdom draws such lessons. I have had very productive meetings with counterparts in Scotland, and Wales can also learn lessons about the importance of transparency and openness, and about recognising potential areas of poor care.
I hope that shadow Ministers will take up those matters with their counterparts in Wales, because such a situation can only be to the detriment of patients there. That is not a political point, but one about good care. It is important for us to deliver that in the system at the moment. It is also important because English patients are treated in Welsh hospitals. My right hon. Friend the Secretary of State is very excited about that point, which is why he is a very strong advocate of the needs of English patients and why he takes a particular and important interest in what happens in Wales, quite rightly drawing comparisons between the two systems.
Robert Francis found, as we have discussed, that individuals and organisations at every level of our health service let down the patients and families whom they were there to care for and protect. That was a systemic failure on the part of everyone concerned and cultural change was needed throughout the system. To prevent the same thing from ever happening again, the Government are changing the culture by requiring transparency and openness, by empowering staff and supporting strong leadership, and by embedding the patient voice and listening when something goes wrong.
Joan Walley
I have listened carefully to the Minister’s response to the various contributions that have been made throughout the debate since 1.15 pm. I hope that he will respond to the points that I made about the current situation in Mid Staffordshire and north Staffordshire before he goes on to the generalities of the Francis report. Does he accept that it was a bombshell when we heard last Wednesday that the recommendations of the trust special administrator had not been accepted in full? We are in a state of limbo. Will he tell the House what is the state of play of arrangements in north Staffordshire and Stafford? We need to know that and cannot deal with the uncertainty.
Dr Poulter
Again, I will not deviate from the general theme of the debate and try your patience, Mr Deputy Speaker. The recommendation of the trust special administrator was that consultant-led services were to be transferred away from Stafford and that there would be a midwife-led unit for Stafford. I am sure that Members on both sides of the House are great proponents of midwife-led units and of increasing the choice that is available. The Secretary of State has made it clear that he accepts the TSA recommendations in full and that local commissioners will have to do a health economy review to assess whether capacity is available elsewhere, before services are moved in the way that was envisaged by the TSA. The Secretary of State has asked NHS England to work with local commissioners to identify whether consultant-led obstetrics could be safely sustained at Stafford hospital. That only happened last week. We will update the House in due course and perhaps statements will be made by NHS England.
Dr Poulter
I have given a very helpful reply to the hon. Lady, but I will give way once more.
Joan Walley
I say to the Minister and the Secretary of State that the use of the phrase “in due course” causes great concern. The new arrangements need to be in place in September 2014. Any delay to the acceptance in full of the recommendations in the TSA report will cause great uncertainty. The Government need to show that they are doing what the Francis report recommended and leading by example. Will they do that in the case of north Staffordshire and Mid-Staffordshire?
Dr Poulter
We are leading by example. As I outlined, the Secretary of State has accepted the TSA recommendation in full. A process is now under way involving NHS England and local commissioners. That was initiated last week. It is important that those conversations happen and that an update is brought forward in a timely manner. That is the right thing to do. It is not appropriate to rush decisions and processes because of a political agenda, rather than an agenda of benefiting the local patients and women concerned. I am concerned as a doctor and as a Minister that we must do the best thing by patients. Rushed decisions are not always the best thing for patients, because conversations need to happen between local commissioners and NHS England. I hope that the hon. Lady will be a little patient, because I am sure that the right decision will be made in due course.
There are three key areas in which the Government have taken forward the recommendations of the Francis inquiry: encouraging a culture of transparency and openness in the health care system; empowering front-line staff and encouraging good leadership in the NHS; and putting the patient at the heart of everything that the NHS does. As we have discussed, the patient was not at the heart of everything that was done at Mid Staffordshire for a period. That is why we have to learn the lessons and ensure, as best we can, that that cannot happen again.
On transparency and openness, it is important to highlight how we have already delivered on the recommendations of Robert Francis’s report. The CQC has appointed three chief inspectors for hospitals, social care and general practice who will ensure not only that the organisation is complying with the law, but that the culture of the organisation promotes the benefits of openness and transparency. Importantly, we now have clinically led inspections for the first time, which means that people who really understand what good care looks like will be in charge of the inspection process. That clinical leadership in the inspection process and at the heart of what the CQC does has to be of benefit to patients, and the Government are proud that we have delivered that.
We have also introduced a new statutory duty of candour on providers, which will come into force this year. It will ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation.
Dr Poulter
The right hon. Gentleman might wish to intervene in a moment, but first I will respond to his good points on the importance of the duty of candour. There is some disagreement between us, because he said that there should be a duty on individuals. He will be aware from his time at the General Medical Council that there is already a duty on professionals to act in the best interests of patients and raise any concerns about the quality of care. As a body, the GMC has learned lessons from Mid Staffordshire and reviewed its processes, but it is important to recognise that many front-line professionals at Mid Staffordshire tried to raise concerns. The culture at the trust was such that those in management positions did not always listen to them. If we want to support whistleblowers and people’s ability to speak out freely for the benefit of patients, that has to be done at organisational level. Health care professionals are already under a duty through their professional obligations, which I hope reassures the right hon. Gentleman.
The right hon. Gentleman has been in the House for many years and will remember that problems of people not being able to speak out freely in their organisations date back to the Bristol heart inquiry. Professor Kennedy, who oversaw that inquiry, noted that it was the cultural problem in that hospital provider that prevented people from speaking out. The problem was not that people were not prepared to speak out—they recognised their professional obligations; it was that there was a wish at a senior level not to recognise problems. That is what we need to tackle. We are now almost 15 years on from the Kennedy inquiry into Bristol—I was a law student at Bristol university at the time—and the NHS has perhaps not learned the lessons that it needs to. I am sure that putting a duty of candour on to NHS organisations will begin to get us where we need to be.
Kevin Barron
Will the Minister consider what I said about how an independent statutory commissioner could examine complaints about patients’ care, as happens in New Zealand? Will he get back to me about whether he thinks that is a good idea? The people who work in the institutions that he is talking about have no faith that anything can be changed.
Dr Poulter
I will talk about complaints a little later, but the right hon. Gentleman has made some important points. When we consider how to improve the delivery of care in our health service, it is important that we examine international comparisons. The system in New Zealand includes a different form of compensation, and perhaps that is partly why it has a more open culture—there could be many other factors. It is acknowledged much earlier in the process that something has gone wrong, and there is a genuine attempt to explain the situation to the family and say sorry. That is what good health care is all about.
No matter how good, well trained and dedicated staff are, things will sometimes go wrong in a health service. When they do, it is important that we are open and honest with patients and that we do our best to put things right if we can, or explain and apologise if we cannot. That is why we believe that the duty of candour needs to exist at organisational level. Of course, I am happy to write to the right hon. Gentleman, or meet him if he would like to talk through some of the issues that he raised today. He makes good points, and I know that he does so on a completely apolitical basis because he has the best interests of the health service at heart. We might disagree on other issues, but on this one it is worth having a meeting to discuss his views further.
Subject to the passage of the Care Bill, a new criminal offence will be introduced to penalise providers who give false or misleading information where that information is required to comply with statutory or other legal obligations. It means that those directors or other senior individuals, including managers, who consent to, connive in, or are negligent regarding an offence committed by the provider could be subject on conviction to unlimited fines or even custodial sentences. We must ensure that managers and those running the health and care service in a health care provider provide information in an honest and transparent way that is always in the best interests of patients.
Importantly, we are introducing through the Care Bill a single failure regime to ensure that failure is not only about the financial sustainability of the trust, but about whether a health care provider is providing good care, and the quality of that care. One problem in the past with the trust special administration regime has been that it is rarely used. When it is used, however, it is important to ensure that it is there to protect patients. Often in the past it was used only in a way that focused on financial failure. One important lesson to learn from Mid Staffs is that there should be a failure regime that also considers quality of care. Hospitals are not just about good accounts; they are primarily about delivering good care, which is why we need a single failure regime. My right hon. Friend the Secretary of State has been a tremendous advocate for the importance of quality of care in trust, and he should be commended for that. Thanks to him, we are now ensuring that we improve the TSA regime in that way.
Mr Jenkin
The Minister is outlining the legislative and regulatory changes that arise from the Francis report, but does he agree with the Health Committee, which attaches far more importance to the leadership academy mentioned by my right hon. Friend the Secretary of State? Is not the quality of leadership much more important to the day-to-day care that is delivered throughout the health service, and will the Minister say a bit more about that?
Dr Poulter
I am not sure whether my hon. Friend has seen my brief, but that was exactly the point I was coming to. He is absolutely right and he highlighted the issue earlier in a strong contribution to the debate. It is important to empower front-line staff to be advocates for patient care and to take leadership roles in hospitals. Clinical leadership is at the core of everything that needs to be done, and we must promote strong leadership throughout a health care organisation, and throughout the sector.
We amended the Enterprise and Regulatory Reform Act 2013 so that a person has the right to expect their employer to take reasonable steps to prevent them from suffering detriment from a co-worker as a result of blowing the whistle. That has supported clinical workers and front-line staff in raising concerns and as whistleblowers. We established the NHS Leadership Academy in 2012 as the national hub for leadership development and talent management. Since it launched its NHS fast-track executive programme in January, there have been more than 1,600 applicants. We are also introducing a new fit and proper person test for directors of registered health care providers, which will allow the CQC to insist on the removal of directors who are responsible for poor care. Those strong steps are in place, and there are others, which I would be happy to discuss another time with my hon. Friend, to embed not just clinical leadership but good leadership throughout our health and care services.
Importantly, in delivering high-quality care and embedding good leadership, we must focus much more on outcomes rather than targets. That goes to the centre of what Robert Francis said, and is led by good clinical leadership. What matters in the health service is that we deliver high-quality care based on good outcomes of care for patients, and we must listen to patients about what good care looks like. The Government are delivering those things, which are at the centre of what Robert Francis recommended as lessons to be learned from Mid Staffs.
Finally, I mention the important issue of embedding the patient voice and listening when things go wrong. As the shadow Minister outlined, the Government have introduced the friends and family test, through which nearly 1.6 million patients have already given instant, real-time, feedback to the NHS about their care. Patients are saying what their experience of care is like. It is not about ticking a box or meeting a target; patients are feeding back information and saying, “Yes my care was good” or “No, my care was not as good as it could have been, and this is how it could be improved.” Good care is about ensuring that we deliver clinical excellence through clinical leadership, listening to patients, and ensuring that we feed back their experiences into delivering better services and a better experience of care. Those are things the Government are doing.
Through the chief inspectors of hospitals, social care and general practice, we are putting proper clinical leadership into the inspection process. We are also ensuring that all feedback from patients, whether concerns voiced on the ward or complaints made once they are back at home, makes a difference. I pay tribute in particular to the work done by the right hon. Member for Cynon Valley on the complaints process, on which there were valuable lessons to be learnt. I thank her for her efforts, which have made a big difference. We are still working on further measures we can put in place to ensure that complaints are listened to. This is all about listening to patients, learning lessons and delivering better care.
We are proud of our record in government in listening to patients and ensuring that we develop proper clinical leadership. We are also proud that, as a result of the Francis report and the measures put in place by my right hon. Friend the Secretary of State, we are beginning to deliver much greater transparency in our health service. It is also important that we have that transparency in the back office. I disagree with what the shadow Minister said about not needing to reorganise the back room. We have to deliver more transparency, better procurement and improvements in how we run the hospital estate. If we do that properly, there will be more money to deliver high-quality patient care.
The coalition Government—I know the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), agrees with me strongly on this—want to see a more productive NHS that is patient-centred and does not waste money in the back office that should be spent on patient care. I make no apologies for organisational steps such as the removal of many of the bureaucratic processes in place under the previous Government, thus saving £1.5 billion a year already. That is good, because it means that more money goes to the front line to deliver high-quality patient care.
The 65th year of the NHS was perhaps its most challenging—certainly in recent memory. The Francis inquiry threw up many challenges for our health and care system, but I believe we are meeting those challenges. Our Government are ensuring that our NHS remains a health service of which we can all be proud, not just today but for many years to come.
Question put and agreed to.
Resolved,
That this House has considered the matter of the Francis Report: One year on.