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The Minister for Community and Social Care (Alistair Burt)
It is a pleasure to serve under your chairmanship, Mr Hanson. I thank my hon. Friend the Member for Fareham (Suella Fernandes) for securing this important debate on the governance of the Southern Health NHS Foundation Trust. I also thank all Members who have spoken, by way of either significant speeches or interventions. The number of colleagues from the area who are involved—from across the House—gives an indication of how seriously we all take this issue. I urge the trust’s representatives to read the report of this debate extremely carefully, so that they absorb everything said by my hon. Friend and all those who have spoken in support.
May I begin by once again apologising to all the patients and families who have been affected by the failure of the trust to provide safe care for its patients? I met Sara Ryan yesterday when I visited the National Forum of People with Learning Disabilities. I had an opportunity to have a conversation with her, and I met more parents and families today before the start of this sitting. Nothing that an official can write on a piece of paper can adequately describe what it is like to meet and talk to families who have been involved in the sort of things that we are talking about here. This is not the first time I have had such meetings: I have had them since coming into post a year ago. It is impossible to convey simply and straightforwardly all that people feel.
What worries me most—I have said this to families in private and I say it again here—is that I hear the same things again and again. I hear about the frustration and concern about the time taken to get anything done when it has been agreed that something should be done, about the time taken to get any answers about what might be done in the first place, and about the defensiveness in the attitude of the institution being dealt with—my hon. Friend the Member for Eastleigh (Mims Davies) described it as a bunker mentality. I do not know whether it is a reflection of a professional attitude—because clinicians and others see things every day—but it is genuinely upsetting to hear people who have lost their loved ones talk about the lack of simple sympathy from those who deal with them. I have heard from enough people in enough different parts of the country to know that what I am hearing is not a one-off.
I also get distressed when I hear through the system that people can be difficult. People have every reason to be difficult, but that is not an acceptable way of describing people who are concerned and upset.
Because this point is made in place after place, as the hon. Member for Liverpool, Wavertree (Luciana Berger) knows well, by many different types of people, I am not sure that the system’s response deals adequately with some of the individual issues that have arisen over the past year—I will come to that later. I say to the parents and families involved that their individual contact, when they get the opportunity, with Members of Parliament and Ministers is not time wasted. It is easy to say that people will feel that only when they see something done, but the contact has a profound impact on officials and Ministers alike.
The first duty of any care provider is to keep its patients safe. The reports of inaction, bordering on complacency, set out in the recent Care Quality Commission report were truly shocking. I responded to an urgent question on the safety of care and services at the trust on 3 May, and I welcome the opportunity provided by today’s debate to update the House on the actions taken in response, several of which pick up on issues raised by the hon. Member for Liverpool, Wavertree and others.
As hon. Members are aware, NHS England commissioned a review by Mazars in November 2014 of deaths of people with a learning disability or mental health problem in contact with the trust between April 2011 and March 2015, in response to serious concerns surrounding the avoidable death of Connor Sparrowhawk. On publication of the report in December 2015, my right hon. Friend the Secretary of State for Health asked the Care Quality Commission to carry out a focused inspection of the trust to review its governance arrangements and its approach to investigating and learning from incidents, as well as its progress in responding to Monitor’s action plan.
On 12 January, Monitor announced further regulatory action in response to the Mazars report, including the appointment of an improvement director for the trust. The CQC inspection took place in January 2016 and led to a warning notice and an announcement of further regulatory action by NHS Improvement, which were both published on 6 April 2016. On 5 May, following the resignation of the trust’s chair, Mike Petter, NHS Improvement required the trust to appoint Tim Smart as the new interim chair. Those actions were in response to the persistent failure of the trust’s senior management to address the environmental and governance risks identified by CQC as far back as October 2014.
The hon. Member for Liverpool, Wavertree and others asked about what has been happening. The issue is split into looking at what has happened and—to use that terribly clichéd phrase—what lessons can be learned, and what is happening now and what confidence people can have in the future. That is vitally important.
I have sought assurances from NHS Improvement and CQC that the regulators are now able to oversee a rapid programme of remedial action by the trust, and I understand that the following measures are now in place. First, at monthly progress review meetings, NHS Improvement challenges the trust’s death and incident reporting action plan and its progress. Secondly, at the request of NHS Improvement, the death and incident reporting action plan is currently subject to external scrutiny. Thirdly, Alan Yates, the improvement director, is acting as a direct link from the trust to NHS Improvement, providing support and constructive challenge to the trust’s board in its oversight of the implementation of the action plan and providing assurance to NHS Improvement and other stakeholders about the trust’s approach.
On the work being done to bring the governance question to a swift conclusion, and in answer to the hon. Lady’s question about pace, the interim chair has already overseen improvements to clinical governance and the trust’s response to the CQC warning notice and NHSI licensing conditions. In parallel, he has commissioned an external review of the capability of the board, which extends to executive and non-executive directors and will inform a decision on leadership by 6 July. That will give the chair, whom I met a couple of days ago, the opportunity to review current capabilities with a view to the future. It is important that he has done that.
Tim Smart has also been in discussion with clinical commissioning groups and other trusts across the local health economy about the provision of services in accordance with the NHS five year forward view, and what that might mean for Southern Health. The transfer of the learning disability service in Oxford to Oxford Health will have been completed by the middle of October.
I spoke to Tim yesterday, and I am absolutely clear that he is right to insist on the highest standards of governance, with leadership concentrating on the real business of the trust—patients and their care. We have an imminent deadline, processes are in place and I am confident that a better Southern Health will emerge, but my confidence counts for very little. It is important that I am able to say that to colleagues with confidence, but the real confidence Southern Health has to gain is that of its patients and families and those who are involved. Having met some of them today, I know that that is a difficult hurdle to overcome, but it is the most important one. A description of processes and what people such as me are doing is not sufficient.
It is necessary that I have said what I have said to colleagues, and that I put on the record that I am confident that NHS Improvement’s review process and its ability to make management and executive changes—which will be carried out by Tim Smart, a newly appointed, experienced chair—is a good response to what has happened. The right person is in place with the power and ability to make the necessary decisions, but any confidence in them will come from the quality of the actions taken as a consequence of the powers invested in the chair and NHS Improvement. Unless actions that have the confidence of people are seen to be taken, something will be lacking. It is important that the chair’s judgment is relied on at this stage, and that I am able to reassure colleagues that the way in which NHS Improvement is working with the chair, and the powers that it and CQC have, are appropriate at the present time, but we must see what happens next.
Nicola Blackwood
The Minister opened by expressing his frustration that, since taking his post, he has been hearing about similar failings again and again. Of course, it is not just us in this place who hear about those failings, but the public and patients too. Every time they do, they lose confidence in the ability of the health service and the Government to address those failings. What in the steps that the Minister and Southern Health are proposing will break that mould? What will be different about the response this time? How will our response to this crisis restore the confidence of our most vulnerable constituents?
Alistair Burt
I will address that a little later, if I may, but I will come to it.
I should also answer the right hon. Member for Oxford East (Mr Smith) on the chain of accountability for NHS Improvement, and on who makes the decisions there. The decisions are made by Jim Mackey, who leads NHS Improvement. He is a direct appointment of the Secretary of State, so the Secretary of State invests his confidence in Mr Mackey, who makes the decisions on the work of NHS Improvement.
I will now turn to some of the issues raised by my hon. Friend the Member for Fareham and others. First, on the position of Katrina Percy, I need to be clear: Ministers have no authority to intervene in such matters, and nor would it be right for them to do so. I have been assured by Jim Mackey, the chief executive of NHS Improvement, that agreed processes are in place to review the performance of the senior leadership team and to make any changes that are in the best interests of patients. A Minister has to leave that there, and is not able to express any further view. That there is confidence in decisions taken is clearly of huge importance to Members in the Chamber, as they have expressed, and to others. A process is in place to decide that, and it will be decided by the chair.
I share my hon. Friend’s concern that inspectors have pointed to repeated failure by the trust to close out necessary improvement actions until the beginning of the year. NHS Improvement has asked the improvement director to ensure that the trust does not treat actions as complete until sufficient robust evidence supports that claim. The repeated failure to complete actions is one of the things that I will come on to in answer to my hon. Friend’s questions. When people are told what to do by a serious regulator, why do they not just do it? Why do they not do it in Southern Health, but do it in other places? What is the point of accountability and what is the process whereby in other parts of public service something is demanded by a regulator—say, in the acute part of the NHS—and something therefore happens, but something does not happen if dealing with those with mental health or learning disability issues?
Mims Davies
Yesterday, Mr Smart told me that his initial view on exactly this point was that the senior executive team had a focus on dealing with Southern Health’s public relations issues, and not really on the care and quality in what was being delivered. That, simply, was why there was no change.
Alistair Burt
My hon. Friend makes her own point about a conversation I was not part of. I am sure people will read what she has to say.
As I have already set out, a clear and robust process is being taken forward by the interim chair to review the capability of the board and to take any necessary action. My hon. Friend the Member for Fareham has called for far-reaching changes. I ask that we await the conclusions of the review and look for the right balance to be struck between continuity and stability to ensure that the trust is able to deliver what it has promised. Wholesale change could introduce further delays to making progress on such work.
Recent media reports have suggested that the trust might be split up. I repeat that the priority now is to ensure safe and effective care in the present and in the future for the population served by Southern Health. NHS Improvement is working with the trust to explore all available options.
Members have also asked why the trust has not been prosecuted for historic safety breaches. I am aware of the allegations of historic health and safety breaches made by a former health and safety advisor to the trust, who has also briefed CQC about such concerns. I share the concerns of all those who are asking why it has taken so long to get a grip on the issues. CQC did indeed identify safety concerns back in October 2014 and has provided an assessment of safety in its most recent report. However, it is unforgivable that patients have continued to be exposed to unnecessary risk while the trust has dragged its feet in resolving the problems.
I understand that CQC has now reviewed evidence gathered during the most recent inspections and additional information obtained from the trust and other public bodies, including the Health and Safety Executive. CQC’s review has identified further lines of inquiry, which it plans to complete as quickly as possible in order to inform a decision on prosecution one way or the other.
Mr Andrew Smith
Is it not the case that following the gathering of that further evidence and, indeed, of other leaked reports of what Southern Health knew at an earlier stage, which had not previously been apparent, the police are now reviewing the case for prosecution?
Alistair Burt
Genuinely, I am unaware of that. The police may review evidence at any time. If CQC has certain evidence that it wishes to take to the police for prosecution, that is a matter for it. I understand the processes that people would want to go through. It is important for me to offer reassurance that those processes are in place, and that things that for too long have been swept under the carpet are open for examination, which I understand to be the case.
Let me deal with the question of a public inquiry. Ministers face many calls for inquiries, and it is important for public inquiries to be considered only where other available investigatory mechanisms would not be sufficient. Public inquiries are rare events. I argue that the processes now being followed by NHS Improvement and CQC are the best way to put right the safety and governance issues at Southern Health. That does not rule out the dissemination of wider learning from this case through NHS Improvement or, where appropriate, the holding to account of individuals via professional regulation or normal performance management routes.
It is right and proper that we should ask such questions. We can perhaps examine whether the system would have responded in the same way had the trust been an acute trust, as I mentioned earlier. I am passionate about improving the care and outcomes for people with mental illness or learning disabilities by ensuring that all aspects of healthcare for people, whatever the issue that has brought them into the care of the NHS and others, are given equal priority with physical health. That must include regulation.
Let me now deal with the point made by my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood). As I have indicated, what I have observed over the past year has worried me. That is to say, there seems to be greater tolerance of when things go wrong in mental health than in acute services. We need to ask ourselves why it has taken so long to resolve those difficulties and to reach the regulatory decisions that are now starting to take effect.
I will therefore be looking at the matter with NHS Improvement, to consider both the effectiveness and the timeliness of regulatory interventions in mental health and learning disability services. I am keen to bring independent leadership into that work, alongside NHS Improvement. A task-and-report group will do a piece of work specifically on that.
Let me name the other places that have upset me during the course of the year. In Hull, there has been a problem with in-patient beds and an inability on the part of the NHS to make decisions about it for more than three years. There was the case of Matthew Garnett, the young man with autism in the wrong place; I could not get information on him for weeks, because of the failure of the NHS to provide what I needed. There are the problems in Tottenham with new mental health facilities, similar to what happened in York, at Bootham Park—how that was closed, and the inability of people to handle it correctly. That is a whole series of cases in which I think things could have been done better. The response has not been good enough. An inquiry into one thing is not sufficient, and the processes are in place to deal with that. Looking at the whole range of why such things happen is really important, and that work is now underway.
Alistair Burt
No, I cannot, because my hon. Friend the Member for Fareham has to have her two minutes.
A further review of the investigation of deaths is being done. It was announced by my right hon. Friend the Secretary of State for Health, but it will not be completed until the end of the year, when the Department will give its response. This has been a hugely important debate, but it is not the end of the matter. It is a staging post, and people will be able to see things following it. I commend my hon. Friend for raising it.