Quality Accounts
Lord Lansley Excerpts(14 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
This Government’s ambition is for health outcomes—and our national health service—to be as good as any in the world. To achieve this, the NHS will need to focus on providing high-quality care, led by empowered clinicians, with the patient at the centre of the service. The NHS, free of bureaucratic interference and the tick-box culture, will make quality improvement the central principle along the entire care pathway, integrated with a reformed social care service.
A quality account is an annual report to the public from providers of NHS healthcare services about the quality of their services. It allows clinicians to demonstrate their commitment to continuous, evidence-based quality improvement. By making boards and leaders of healthcare organisations visibly accountable for service quality, in the same way that they are responsible for finances, quality accounts put what matters to patients at the heart of the NHS.
Quality accounts require boards and leaders of healthcare organisations to review quality across all of the healthcare services they offer, and to identify objectives for continuous quality improvement that meet the needs of the public they serve. They are therefore a tool to empower providers and patients to produce the best possible outcomes of care.
The first quality accounts—for providers of acute national health services—have now been published. They are available from the providers themselves, and from the www.nhs.uk website.
We want staff, patients and the wider public to read their local providers’ quality accounts, and then make their views known to the boards and leaders of those providers. The public’s input to their local quality accounts has demonstrated a great willingness to get involved—which provides a clear spur for boards of provider organisations to focus their attention on improving patient care.
This is a step towards focusing the NHS on continuous quality improvement, and allowing patients to see the information they need to make an informed judgment about that commitment to quality improvement. More needs to be done to standardise our definition, measurement and reporting of service quality—along lines that clinicians will recognise as evidence-based and be accountable for. We need to drive up the range and quality of information published, to enable patients to exercise choice. Quality accounts help with this transformation.
For the future, quality accounts will evolve to reflect the Government’s aim of developing a new culture of leadership and responsibility across the NHS. Following a formal evaluation over the summer, we will consult on how the potential of quality accounts can be better realised, including by:
relating the content to emerging outcome measures and quality standards;
building in third party assurance through external audit; and
extending quality accounts to primary and community care providers, following the evaluation of the pilots in the North-East and East Midlands strategic health authorities.
Proposals will be consulted on in the autumn, with updated regulations and guidance to follow later in the year.
H1N1 Pandemic
Lord Lansley Excerpts(14 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have today placed a copy of the report of the independently chaired review of the United Kingdom response to the 2009 H1N1 (“swine flu”) pandemic in the Library of the House. Copies are available to hon. Members from the Vote Office. The review was jointly commissioned, and the chair appointed, by all four of the UK Health Ministers in March 2010. Dame Deirdre Hine chaired the review.
The four UK Health Ministers set up this independent review with a remit to review the appropriateness and effectiveness of the UK strategy for responding domestically to the swine flu pandemic, and make recommendations for any future influenza pandemic. The review was not asked to comment on operational matters.
I would like to thank Dame Deirdre Hine and her team for their work and I welcome her report and recommendations. I will take these into account, alongside financial and operation considerations, and other research evidence, when reviewing our future pandemic plans in the national framework for responding to an influenza pandemic.
I would like to express the Government’s thanks to everyone who has assisted and advised on the response to the swine flu pandemic.
Oral Answers to Questions
Lord Lansley Excerpts(14 years, 6 months ago)
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Lilian Greenwood (Nottingham South) (Lab)
1. What steps he is taking to improve rates of early detection of cancer.
The Secretary of State for Health (Mr Andrew Lansley)
Late detection of cancer is one of several reasons why our cancer survival rates are below the European average. That is why we will focus on improving those outcomes and achieving better awareness of the signs and symptoms of cancer. These aims will be part of our future cancer strategy.
Lilian Greenwood
Over half the men who receive a testing kit under the national bowel cancer screening programme throw it away. What action is the Secretary of State taking to improve the take-up of screening, particularly by men, and what provision has he made within the NHS budget for the extra costs of increased take-up?
Mr Lansley
I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby—it looks after people in parts of the midlands and the north-west—and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.
Mr John Baron (Basildon and Billericay) (Con)
The recent inquiry of the all-party parliamentary cancer group into cancer and equalities heard expert evidence to suggest that if people can survive the first year of cancer, their chances of surviving for five years are almost identical to the chances in the rest of Europe. Does the Secretary of State therefore believe that a one-year survival indicator is a good idea both for encouraging early diagnosis and for matching the survival rates of the best in Europe?
Mr Lansley
My hon. Friend makes an extremely good point. When we set out proposals for an outcomes framework, I hope that he and others will respond, because that is one of the ways in which we can best identify how late detection of cancer is leading to very poor levels of survival to one year. I hope that we can think about that as one of the quality indicators that we shall establish.
Diana R. Johnson (Kingston upon Hull North) (Lab)
I welcome the Secretary of State to his new position and wish him well in his role. I understand that he is keeping the two-week target for seeing a cancer specialist, but abandoning the work that the Labour Government did on the one-week target for access to diagnostic testing. Professor Mike Richards stated in the annual cancer reform strategy that improving GP access to diagnostic tests is essential to the drive for early diagnosis of cancer. Can the Secretary of State spell out some of his current thinking on what the alternative would be if we no longer have the one-week target?
Mr Lansley
Let me make it clear to the hon. Lady and the House that only 40% of those diagnosed with cancer had actually gone through the two-week wait. Establishing a better awareness of symptoms and earlier presentation across the board is, as we have been discussing, important to achieve. I am afraid that the hon. Lady is wrong: I have not said that we are abandoning any of the cancer waiting-time targets at the moment, but that we have to be clear about what generally constitutes quality. For example, seeing a cancer specialist without having had prior diagnosis is often pointless, whereas getting early diagnosis is often a serious indicator of quality.
Derek Twigg (Halton) (Lab)
2. What assessment he has made of the effects on NHS waiting times of NHS targets in the last 10 years.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
4. What steps he plans to take to implement the Government’s proposals to end the target culture in the NHS.
The Secretary of State for Health (Mr Andrew Lansley)
On Monday 21 June I published a revision to the NHS operating framework in which I removed the central management of three process targets that had no clinical justification. We will carry on focusing on quality and outcomes, getting rid of top-down process targets.
Dr Poulter
Does my right hon. Friend agree that meeting targets does not necessarily mean improving health care, and that the last Government were far too focused on the process of health care, rather than on improving the patient experience?
Mr Lansley
My hon. Friend is absolutely right. I was here just a few weeks ago, announcing a public inquiry into the events at Stafford general hospital. Of course, in that hospital the adherence to ticking the box on the four-hour target was one of the things that contributed to the most appalling care of patients. We have to focus on delivering proper care for patients—the right treatment at the right time in the right place—and delivering the best outcomes for them. We will focus on that—on quality—not on top-down process targets.
Chris Leslie (Nottingham East) (Lab/Co-op)
Is it really true that the coalition Government are going to scrap the right for people to see their GP within 48 hours? If so, will the Secretary of State publicise that, so people know that the right has been reduced? If it is true, is he not just axing public service quality under the pretence of dealing with so-called bureaucracy?
Mr Lansley
It is astonishing—the Labour Government spent money trying to achieve the GP access target, and the hon. Gentleman might at least have recognised that the latest data, published two or three weeks ago, show that public satisfaction with access to their GPs, and the things that the Labour Government had been paying for, had actually gone down. A consequence of the 48-hour access target was that patients were unable to access their GPs more than 48 hours in advance. Is it not reasonable to expect GPs to be able to manage their own services in order to deliver better patient experience and outcomes across the board? I think we can reasonably expect that.
Nadine Dorries (Mid Bedfordshire) (Con)
It has been reported today that historically speaking, as a result of targets, an obstetrician in a hospital could herself have a caesarean section but then have to refuse one to a patient, because of the pressures that targets put on the local NHS trust. Can the Secretary of State give us an assurance that any woman in the NHS who needs a caesarean section will have one, and that no targets will be imposed?
Mr Lansley
My hon. Friend is referring to World Health Organisation targets, which have not in themselves been applied within the NHS, and it certainly would not be my intention to impose such targets. I agree with the implication of her question, which is that a woman who needs a caesarean section should have access to one. I am also well aware that when a woman does not require a caesarean section we should seek, through a process of discussion and providing information, to avoid that wherever possible. Birth should be considered a normal event, rather than being subject to excessive medicalisation.
Mrs Madeleine Moon (Bridgend) (Lab)
5. What his most recent assessment is of the adequacy of the level of support provided for people with low vision.
Mr Dominic Raab (Esher and Walton) (Con)
11. What steps his Department is taking to increase participation by local people in NHS decision making.
The Secretary of State for Health (Mr Andrew Lansley)
I have stopped top-down reconfigurations where the NHS has not listened to local people. Our coalition agreement is clear that we will give patients more control over their own health care, and give patients and the public a stronger voice in the design of local health and care services.
Mr Raab
NHS managers have justified cuts in community hospitals in Walton, Cobham, Molesey and other parts of the country on efficiency grounds, but in 2009, because of targets, almost 1 million patients were discharged and then readmitted within 30 days, at a cost of £1.6 billion. What plans has the Secretary of State to strengthen local democratic control over community hospitals and the vital services that they provide?
Mr Lansley
My hon. Friend has raised an important issue. Let me make two points. First, we need to strengthen not only the local public and patient voice but the voices of GPs who are involved in commissioning, so that they can act on behalf of their patient population in commissioning the services, and design of services, that they need. Secondly, as I have made clear in the revision of the operating framework, we must look at results. When someone goes into hospital for treatment, we must consider not just their treatment in the hospital, but their subsequent rehabilitation and re-ablement. I believe that that will allow greater use of intermediate care beds in the way that my hon. Friend has described.
Hazel Blears (Salford and Eccles) (Lab)
I thank the Secretary of State for agreeing to meet me—together with representatives of my local primary care trusts, local mums and midwives—to discuss maternity services in Salford. In the light of his new criteria for reconfigurations, will he confirm that he is prepared to reconsider the decision to close Salford’s maternity services, and to recognise the views of thousands of people throughout Salford and Eccles, including me, who opposed it at the time?
Mr Lansley
The right hon. Lady knows that we will meet to discuss the issue. However, as I said when I was in Greater Manchester, it is not for me to reconsider the application of the new criteria from 21 May. That is for local people to reconsider. It is for GPs, the public, local authorities and, indeed, PCTs in Salford and district to start thinking about what they consider to be viable and successful future services for mothers-to-be.
Mr Edward Timpson (Crewe and Nantwich) (Con)
In helping local people to become more involved in NHS decision making, will my right hon. Friend agree to consider my Ambulance Response Times (Local Reporting) Bill, which received its Second Reading during the last Parliament? The Bill requires all ambulance trusts to publish local as well as regional response times and patient outcomes so that—as is already the case in Crewe and Nantwich—they have access to those details and can deliver better response times, with the help of local initiatives such as Community First Responders.
Paul Goggins (Wythenshawe and Sale East) (Lab)
12. What his policy is on maximum waiting times in accident and emergency departments; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
From April 2011, the accident and emergency four-hour waiting time standard will be replaced by a set of clinical quality standards, developed with clinicians, which will support quality care without the damaging distortion of the four-hour tick-box target. On the basis of clinical advice, I have immediately reduced the threshold for meeting the four-hour standard from 98% to 95%.
Paul Goggins
I am sure that the Secretary of State will want to join me in congratulating the staff at Wythenshawe hospital in my constituency. Last year 85,000 patients were seen in the accident and emergency department, 98% of them within four hours. Can the Secretary of State explain to my constituents why he has decided that this year 4,500 of those patients will not need to be seen within that time?
Mr Lansley
As I told the right hon. Gentleman, I made that decision on the basis of clinical advice. It was clear that the 98% standard was distorting clinical care for patients. There is no benefit for patients if, for the purpose of meeting a four-hour target, they are discharged inappropriately, transferred to wards when they have not been thoroughly looked after in the accident and emergency department, or indeed put in an observation ward for 48 hours, which is under the scrutiny of the accident and emergency department but ticks the box. None of that helps patients. I will focus on what is actually in the best interests of patients, and delivers the right outcomes for them.
Philip Davies (Shipley) (Con)
17. What recent representations he has received on the appropriateness of the remit of the National Institute for Health and Clinical Excellence; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
Since 7 May, the Department has received about 120 representations from hon. Members, noble Lords and members of the public on a range of issues concerning the National Institute for Health and Clinical Excellence, including its remit.
Philip Davies
May I urge the Secretary of State to get NICE to go back to what most people think it is for, which is monitoring the cost-effectiveness and clinical effectiveness of drugs? Many people do not think that it does a particularly good job on that, anyway, but it is currently indulging in empire building, with its ridiculous drivel in recent weeks about smoking breath tests for pregnant women, compulsory sex education for five-year-olds and subsidies for food companies to make healthier food. Surely it ought to go back to what it should be doing, and do it better, rather than empire building, as it is doing.
Mr Lansley
In 2005 the previous Government charged NICE with producing public health guidance as part of its work. As I establish a more integrated and effective public health service, I shall consider how the advice of NICE fits into that strategic framework.
Mike Gapes (Ilford South) (Lab/Co-op)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley)
My responsibility is to lead the NHS in delivering improving health outcomes in England; to lead a public health service that improves the nation’s health and reduces health inequalities; and to lead the reform of adult social care that supports and protects vulnerable people.
Mike Gapes
When the new Secretary of State intervened to stop the reorganisation of health services in London, he said that there would be no forced closures. Can he give me an unambiguous and categorical assurance that he will not allow the closure of the accident and emergency department, the children’s surgery or the maternity services at King George hospital in Ilford? Yes or no?
Mr Lansley
The hon. Gentleman’s question seems rather churlish, given that he wanted to stop the top-down configuration that NHS London imposed so that people in his area—GPs, the local authority, local people and patients—could have an opportunity themselves to decide how services might best be designed for local people. That is the pledge that I have made. Those criteria will enable that process to be led locally, rather than imposed and forced on people.
Lorraine Fullbrook (South Ribble) (Con)
T4. St Catherine’s hospice is used by many of my constituents, and they will be pleased to be able to go ahead with the hospice’s planned improvements, which will be funded through the capital grants programme. Does the Secretary of State agree, however, that the excellent work of such hospices goes far beyond the hospice building? What will his Department do to ensure that hospices play a greater role in providing services to the local community?
Mr Lansley
I am very grateful to my hon. Friend, who will know that I entirely understand and applaud the work of St Catherine’s hospice, because we have visited it together. She makes a very important point, because those whom I know in the hospice movement want to think not just about the service that they provide in their buildings, but about an holistic service for patients’ families and for those who require palliative care. I might just say that on Saturday I made it clear that up to £30 million will be available in this financial year to support children’s hospices, specifically, in extending their work so that they can provide a service in the community for children with life-limiting illnesses.
Andy Burnham (Leigh) (Lab)
The right hon. Gentleman will remember our exchanges at the election hustings, where there was a real difference between us: we said that we would protect the NHS budget in real terms, and I stand by that commitment; the right hon. Gentleman said that he would increase the NHS budget. After last week’s Budget, however, we now know the price of that commitment: 25% cuts to social care will mean vulnerable people either left without the support that they need or facing higher charges to pay for care, and huge pressure on carers. It means also that the NHS itself stops working, because it cannot discharge people from hospital when there is no support in the community. That unbalanced approach to public spending is dangerous and will decimate services on which the NHS depends. Is it not time to drop a pledge that had more to do with votes and nothing to do with people’s lives?
Mr Lansley
So there we have it, Secretary of State. [Hon. Members: “Secretary of State?”] I meant “Mr Speaker”—you are far more elevated than a Secretary of State, Mr Speaker.
The shadow Secretary of State’s belief is that the NHS budget should be cut. I fail to see how that could help social care. We are going to look much more positively at how we can join up the work of the NHS and social care. What my colleagues and I have announced on 30-day support for patients leaving hospital, including rehabilitation and re-ablement, will do precisely that, relieving some of the pressures on social care by seeing the NHS as a more holistic service for patients.
Dr Julian Huppert (Cambridge) (LD)
T5. Does the Secretary of State accept the conclusions of the Science and Technology Committee’s report “Evidence Check 2: Homeopathy”? Earlier, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) gave a commitment to an evidence-based approach and today the British Medical Association passed a motion about homeopathy. Given the financial constraints in which we all share, can the Secretary of State defend spending millions of pounds of NHS money on methods that simply do not work?
Toby Perkins (Chesterfield) (Lab)
T2. My right hon. Friend the shadow Secretary of State referred to the Commonwealth Fund report, which said that Britain’s NHS was the most efficient. Does that not make it clear that after 13 years of a Labour Government, the NHS is not just so much better for patients, but efficient? To say that it is not is an insult to the people who have worked so hard to make it great.
Mr Lansley
I have looked at the reports of the Commonwealth Fund for a number of years; it regards the NHS as efficient because it spends relatively little in comparison with other health economies. In this country, we need to recognise that the NHS does not spend very much in comparison with other countries but it could spend it more efficiently. There has been declining productivity for 10 years. [Interruption.] The shadow Secretary of State needs to recognise that NHS management costs went up by 63% while nursing costs went up by just 27%. My colleagues and I are committed to halving NHS management costs and to reducing the costs of the NHS, through efficiency, by £20 billion. Every penny of that will be reinvested in meeting the rising demand for the NHS and the improvements in quality that we require.
Duncan Hames (Chippenham) (LD)
T7. What encouragement is the Secretary of State giving to primary care trusts to restore minor injury services to towns such as Melksham in my constituency? It saw its minor injuries unit close under the last Government.
Jim Shannon (Strangford) (DUP)
One of the concerns of a great many of us recently has been the availability of cancer care drugs. [Interruption.] Right across—right across, Mr Speaker, the whole United Kingdom, and Northern Ireland in particular, a great many people have not been able to access cancer care drugs and have had to endure sickness and illness without them. Can the Secretary of State assure the House today that cancer care drugs will be made available and that those who are ill and suffering from cancer can rest easy?
Mr Lansley
We have been very clear that it is a scandal that we have some of the finest cancer research anywhere in the world and some of the best cancer medicines have been developed in this country, yet in the past in this country NHS patients have often been the last to have access to those drugs. That is why at the election we made it clear that we will introduce from April next year a cancer drugs fund, the purpose of which will be to ensure that patients get access through the NHS to the cancer medicines that they need, on clinical recommendation and advice, and that they are not unduly delayed in getting that access.
Julian Sturdy (York Outer) (Con)
T9. I am sure that the Secretary of State will remember visiting my constituency earlier in the year and listening to constituents’ concerns about the withdrawal of spinal injections on the NHS. Given that the PCT’s decision is set to become another example of the postcode lottery in the health service, will his Department consider the ongoing debate about spinal injections in York and support the attempts of my constituents as they seek to shape local health services around their specific needs?
Vernon Coaker (Gedling) (Lab)
T3. Does the Minister agree that it is crucial for patients to have information if we are to make a reality of choice within the NHS? In that respect, does he agree that if we are to give people a real choice as regards the choose and book system that GPs operate, there is a need to ensure that patients have the information about the success rates of different hospitals, and different surgeons, as regards operations?
Mr Lansley
I agree with the hon. Gentleman—it is just that that did not happen under a Labour Government in the way that it should have done. For example, the national quality registers in Sweden have 69 areas of clinical practice for which such comparative data are published. I have made it clear that one of our priorities is that we focus on outcomes and on giving patients real empowerment. To do that, information for patients on outcomes will be absolutely critical.
Dr John Pugh (Southport) (LD)
T10. I have here a letter from my local PCT indicating that the clinical review of the safety of a proposed children’s walk-in centre in Southport is to be conducted by Dr Sheila Shribman and the Minister’s Department. Will the Minister arrange to meet me and relevant officials to ensure that the Department is properly aware of the background to this vital access issue and that we have a clinical network suitable for patients, as well as for practitioners?
Mrs Mary Glindon (North Tyneside) (Lab)
T6. Every year in the north-east, 300 children are born with congenital heart disease. These very sick children receive expert treatment locally in the world-class cardiothoracic unit at Newcastle’s Freeman hospital. Can the Minister assure my constituents, who value this vital local service, that the findings of Sir Ian Kennedy’s review of children’s heart surgery centres will be implemented without financial constraint?
Mr Lansley
I should tell the hon. Lady that it is premature to make any commitment about the review, because we now need to have proper engagement with local people, patients and those who are responsible to focus on how we can make absolutely certain that the outcomes that we achieve for children requiring cardiac surgery are as good as we can possibly make them.
Robert Halfon (Harlow) (Con)
Will the Minister review the problem of highly priced patient lines and introduce competition so that patients in Harlow and elsewhere no longer pay extortionate prices to watch TV or make phone calls?
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
The Secretary of State has halted the reconfiguration of services in south-east London, which was clinically led, the subject of detailed public consultation and approved by the reconfiguration panel. The outcome is to leave my PCT and hospital trust acutely troubled about their ability to deliver the improved health services that were promised under “A picture of health” and to meet their financial targets. What does that say about the Government’s commitment to evidence-based policy making?
Mr Lansley
What we have done in London is to give those who would be most affected by decisions to reconfigure services the opportunity, where decisions have not already been made, to have a local say. That includes patients, the public and GP commissioners. The delay, in so far as there is any delay, need not be great if those proposals are fully subscribed to by local people and by their GPs as commissioners.
David Tredinnick (Bosworth) (Con)
Would my right hon. Friend accept that there is widespread anecdotal evidence of the effectiveness of homeopathic medicines? There are 500 doctors in this country who use them, and nobody is obliged to have them if they do not want them. Will he therefore heavily discount the illiberal views of our hon. Friend the Member for Cambridge (Dr Huppert)?
Alex Cunningham (Stockton North) (Lab)
The North Tees and Hartlepool NHS Foundation Trust believes that its strategy for one hospital to replace the North Tees and Hartlepool university hospitals is the right strategy, despite the project being dropped by the Government. Does the Minister accept that the trust’s strategy to provide a new hospital and health facilities closer to communities to meet their health needs is correct, that the trust should be encouraged to press ahead with alternative funding models that could still deliver the new hospital, and that its members and the public at large can expect Government support to realise that strategy?
Mr Lansley
What I would look for is for the foundation trust to meet the criteria that I published on 21 May in relation to any reconfiguration of services that it proposes for its area. As a foundation trust, I would also expect that, having secured the freedoms associated with that status, it should not ask the Department of Health to meet the whole capital cost of whatever it proposes.
NHS Operating Framework
Lord Lansley Excerpts(14 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
Today I am publishing a document setting out the revisions to the NHS operating framework for 2010-11. The document has been placed in the Library and copies are available to hon. Members from the Vote Office.
In now moving towards a health service which puts patients at the heart of decision making, which focuses on quality and outcomes not processes, and with more devolved responsibilities, this short document sets out a number of areas subject to immediate change.
The Department will cease to centrally performance-manage the previous Government’s targets on 18-week waiting times and access to primary care. More clinically relevant accident and emergency indicators will be developed for 2011-12. Locally led plans should deliver improvements in median waiting times and access.
The coalition Government are committed to stopping top-down reorganisations of the NHS that have got in the way of patient care. To that end, a moratorium is in place for future and ongoing reconfiguration proposals. All current and future reconfiguration proposals will need to meet four new tests as I set out in the document; and can go forward, if and when they do so.
I shall set out that primary care trusts (PCTs) should accelerate the process to transform community services with clear deadlines.
I have asked each strategic health authority (SHA) region to now go further, faster, to release all possible resources to meet demand and quality challenges. The overall ceiling for management costs in PCTs and SHAs will now be set at two thirds of the 2008-09 management costs (£1,509 million), the ceiling will therefore be £1,006 million. In aggregate, PCTs and SHAs will need to save at least £222 million in 2010-11 and a further £350 million by the end of 2011-12.
I am asking NHS organisations to ensure that they demonstrate similar discipline to central Government on consultancy, marketing and information, communications and technology spend, recruitment, and centralised procurement for goods and services.
The number of best practice tariffs shall be expanded where payment is linked to best practice care, as well as expanding the list of never events so that no payment is made for services, which compromise patient safety.
I announced on 8 June 2010 my intention to make hospitals responsible for patients 30 days after discharge, one of the key health commitments in the coalition agreement. If a patient is re-admitted during that time, the hospital will not receive any further payment for the additional treatment. Making hospitals responsible for a patient’s ongoing care after discharge will create more joined-up working between hospitals and community services and may be supported by the developments in re-ablement and post-discharge support. This will improve quality and performance and shift the focus to the outcome for the patient.
These are the only changes I am making in-year. The remainder of the NHS operating framework 2010-11, which was published on 16 December 2009, still stands and I expect the NHS to play its role when partnership approaches are needed to secure better outcomes.
NHS South West
Lord Lansley Excerpts(14 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
I have asked Sir David Nicholson, chief executive of the NHS in England, to initiate a review into the approach and behaviour of the NHS South West in relation to Royal Cornwall Hospitals Trust, in particular, to the dismissal of John Watkinson and, by association, the trust’s position in relation to the provision of upper gastro-intestinal (GI) services in Cornwall.
John Watkinson was dismissed from his role as chief executive of the Royal Cornwall NHS Trust in April 2009. He took his case to employment tribunal, which has recently published its judgment that he was unfairly dismissed.
In the opinion of the employment tribunal, John Watkinson was unfairly dismissed because he made a “protected disclosure” covered by the Public Interest Disclosure Act. The disclosure was linked to the reconfiguration of upper GI services in Cornwall. The employment tribunal also found that Royal Cornwall NHS Trust acted as it did as a result of pressure from the South West Strategic Health Authority (NHS South West).
Verita, a specialist company that conducts independent investigations, reviews and inquiries has been commissioned to undertake this review.
The Terms of Reference for this review will be;
to examine all the SHA’s interactions with the Royal Cornwall Hospitals NHS Trust in relation to the dismissal of John Watkinson and, by association, the trust’s position in relation to the provision of the upper GI services in Cornwall. In particular, to determine:
the chronology of events and decisions made in the running up to the dismissal of John Watkinson;
what involvement NHS South West had in his dismissal and whether or not this was motivated by the reconfiguration of upper GI services or otherwise; and
whether the SHA acted appropriately, proportionately, in keeping with its role and within its statutory responsibilities.
The review should not duplicate the review of the upper GI service configuration which was recently carried out by the independent reconfiguration panel, nor any subsequent appeal of the employment tribunal’s decision. However, it may consider these and any other relevant background evidence to make its determinations.
The findings of the review will be published later this year and I will update the House on the outcome of the review and my response.
Mid Staffordshire NHS Foundation Trust
Lord Lansley Excerpts(14 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
With permission, Mr Speaker, I wish to make a statement on Mid Staffordshire NHS Foundation Trust.
In March last year, the Healthcare Commission’s report on Mid Staffordshire and the appalling failures in patient care that it laid bare shocked us all. Three reports later, and I am announcing today what should have been announced then: a full public inquiry into how these events went undetected and unchallenged for so long. The inquiry will be held in public, including the evidence, the oral hearings and the final report. We can combat a culture of secrecy and restore public confidence only by ensuring the fullest openness and transparency in any investigation.
So why another inquiry? We know only too well every harrowing detail of what happened at Mid Staffordshire and the failings of the trust, but we are still little closer to understanding how that was allowed to happen by the wider system. The families of those patients who suffered so dreadfully deserve to know, and so too does every NHS patient in this country.
This was a failure of the trust first and foremost, but it was also a national failure of the regulatory and supervisory system, which should have secured the quality and safety of patient care. Why did it have to take a determined group of families to expose those failings and campaign tirelessly for answers? I pay tribute again to the work of Julie Bailey and Cure the NHS, rightly supported by Members in this House.
Why did the primary care trust and strategic health authority not see what was happening and intervene earlier? How was the trust able to gain foundation status while clinical standards were so poor? Why did the regulatory bodies not act sooner to investigate a trust whose mortality rates had been significantly higher than the average since 2003 and whose record in dealing with serious complaints was so poor? The public deserve answers.
The previous reports are clear that the following existed: a culture of fear in which staff did not feel able to report concerns; a culture of secrecy in which the trust board shut itself off from what was happening in its hospital and ignored its patients; and a culture of bullying, which prevented people from doing their jobs properly. Yet how these conditions developed has not been satisfactorily addressed. The 800-page report by Robert Francis QC, published in February, gave us a forensic account of the local failures in that hospital and the consequences for patients, but, like its predecessors, his report was limited by its narrow terms of reference.
I am pleased to say that Robert Francis has agreed to chair the new inquiry, and he will have the full statutory force of the Inquiries Act 2005 to compel witnesses to attend and speak under oath. Clearly these are complex issues, and Robert Francis has already said he wants to establish an expert panel that can help support him through this process. However, it is important for everyone that the inquiry be conducted thoroughly and swiftly, with the aim of providing its final report and conclusions by March 2011.
I also want to assure the House, however, that we will not wait to take earlier action where necessary. I can therefore announce today that we are going to give teeth to the current safeguards for whistleblowers in the Public Interest Disclosure Act 1998 by: reinforcing the NHS constitution to make clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing; seeking through negotiations with NHS trade unions to amend terms and conditions of service for NHS staff to include a contractual right to raise concerns in the public interest; issuing unequivocal guidance to NHS organisations that all their contracts of employment should cover staff whistleblowing rights; issuing new guidance to the NHS about supporting and taking action on concerns raised by staff in the public interest; and exploring with NHS staff further measures to provide a safe and independent authority to which they can turn when their own organisation is not listening or acting on concerns.
In the coming weeks we will introduce further far-reaching reforms of the NHS that go to the very heart of the failures at Mid Staffs. This is not about changes in processes or structures; it is about a wider shift in culture, putting patients at the heart of the NHS and focusing on the things that matter most to them. That includes putting the focus on safety. At Mid-Staffs, safety was not the priority. It was undermined by politically motivated process targets. The first Francis inquiry was crystal clear on that point. It said:
“This evidence satisfies me that there was an atmosphere in which front line staff and managers were led to believe that if the targets were not met they would be in danger of losing their jobs. There was an atmosphere which led to decisions being made under pressure about patients, decisions that had nothing to do with patient welfare. As will be seen, the pressure to meet the waiting target was sometimes detrimental to good care in A & E.”
We will scrap such process targets and replace them with a new focus on patients’ outcomes—the only outcomes that matter. We will empower patients with access to information, giving them the ability to hold their own records, to make informed choices and to interact more readily with clinicians. We will put power in patients’ hands. Ultimately, if patients had been informed and empowered, and if people had listened to them rather than obsessing about centrally mandated processes and targets, these scandalous failings could not have gone unchallenged for so long.
In closing, I want to say a word about the trust itself. It is so important that the hospital and the trust, which have been under such an intense spotlight, should be able to continue to improve services for the patients they serve and continue to rebuild the trust and the fractured confidence of their community. Staffing there has increased, with more than 140 more nurses recruited since March 2009. Processes are more open and transparent, and monthly board meetings are now being held in public. Results are improving: the hospital standardised mortality ratio there is now significantly lower, and the rate of healthcare associated infections has improved. The Care Quality Commission will, in the coming weeks, provide its considered view on that progress, when it publishes the findings of its “12 month on” review.
We cannot and should not underestimate the task still ahead, and the attention of the trust must not be unduly diverted. That is why I am clear that this further inquiry should not cover ground already covered in the first Francis inquiry, and that it should, as far as possible, ensure that it supports all those staff who are working so hard to bring about the necessary changes. When this inquiry has completed its work and I return to the House to present its report, I am confident that we will, for the first time in this tragic saga, be able to discuss conclusions rather than just questions. We will be able to show that we have finally faced up to the truths of this terrible episode and that we are taking every step to ensure that it is never allowed to happen again. That is a basic duty of any Government. For the people of Staffordshire—many of whose relatives suffered unbearably in the closing stages of their lives—and for the nation as a whole, this is the very least they are entitled to. I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
I begin by thanking the Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley) for his statement, much of which I welcome. It will be hard for the people of Stafford and for the staff at the hospital to hear that their town and their hospital are in the news again today, and it is important to say at the outset—as the Secretary of State did—that this inquiry relates to historical events at the hospital and that the situation there has been improving ever since. I should like to put on record my own personal appreciation of the role played by the new chair and chief executive of Mid Staffordshire NHS Foundation Trust in improving standards at the hospital, rebuilding confidence and rebuilding the important relationships with the local community.
Events at the hospital between 2006 and 2008 represent one of the darkest chapters in our national health service. As the Francis report—which ran to two volumes and more than 900 pages—documented, there were appalling failures at every level, from basic care and human compassion on the wards to a failure in the duty of care at board level towards staff, patients and the whole community.
The NHS and its values are part of what makes our country great, but the NHS is not perfect. When things go wrong, it has a tendency to push people away and bring down the shutters. Yes, it is hard to deal with complaints when they affect matters of life and death, but it is only by holding up a mirror to the national health service that we will get an open, learning health service that learns from its mistakes and ensures that they are not repeated. That is why I took the decision to commission the original Francis report. It is also why, before the election, I signalled the need for a second-stage inquiry, to be held in public, into the actions of the supervisory and regulatory bodies, right up to the Department of Health. I therefore give the Secretary of State the assurance that this new inquiry will have the Opposition’s full co-operation, from the very top right the way down.
We published the draft terms of reference for that second-stage inquiry before the election. Will the Secretary of State therefore explain to the House what questions or areas it will consider that were not covered either by the Francis report or the draft terms of reference that we laid before this House and on which we sought comments from a wide range of organisations? Also, what is different about the inquiry that he has announced, compared with the one that we proposed?
How long will the new inquiry take, and how much will it cost? Will he give the House an assurance—as I think that he did in his statement—that he will ensure that it does not distract the trust from the overriding task of ensuring that the hospital continues to make the necessary improvements? Will he also make sure that the trust’s leadership can continue to focus on improving relations with the local community?
Will the right hon. Gentleman give me an assurance that the recommendations of the original Francis report will continue to be implemented in full while the new inquiry takes place? He will know that Robert Francis concluded in his original report that many people came forward who would not have done if the inquiry had been held under a different status. I gave Robert Francis the ability to come back to me to ask for further powers if they were necessary, but may I ask for the right hon. Gentleman’s assurance today that the status of the new inquiry will ensure that all the people who need to speak to it do come forward and give evidence?
On NHS targets, I was disappointed by the Secretary of State’s comments in his statement, and by those of the Prime Minister a few moments ago, as they appear to be prejudging the inquiry that they have set up today. Trusts up and down the country are implementing national standards safely. Indeed, targets are about patient safety: the four-hour A and E target is the basic minimum that every person in this country can expect when arriving at the door of the NHS.
The targets were implemented and brought in because some years ago, people were waiting for hours on end—almost whole days—in A and E departments. If the Secretary of State is resolved to remove that standard in the NHS, which many of the professional health bodies support, will he therefore give us an assurance that we will not see a rise in A and E waiting times? What mechanism will he implement to ensure that?
The trust’s board allowed staffing to fall to dangerously low levels, with 120 whole-time equivalents lacking from the wards. I put it to the Secretary of State that that was the main reason for the failures at the trust. I am sure that he will agree with me that not all the staff then working at the hospital are to blame, and that there are many good, decent, hard-working people at the hospital who will again find it hard to see their place of work back in the news today. There will also be many staff across the NHS who will feel that there is a daily focus on their failings but very little recognition of the outstanding professional standards that they show, or of the millions of acts of human kindness that take place in our NHS day in and day out.
In closing, may I ask the Secretary of State to give the House an assurance that he will always present a balanced picture and, in this case, be clear that these were isolated events at an isolated hospital?
Mr Lansley
I am grateful to the right hon. Gentleman for indicating that he supports this further inquiry, and that he and his colleagues will give it that support. They will know that for more than six years as shadow Secretary of State I always gave both a balanced and positive view of what the staff of the NHS achieve daily on our behalf. That extends to the staff at Stafford hospital, as I have made clear to them when I have visited them in the past. Indeed, I shall be visiting again tomorrow in order to make that even clearer—and I have asked Robert Francis to ensure that as he conducts his inquiry, he does whatever he can not to divert them from continuing to improve care for people in Staffordshire.
The right hon. Gentleman asked what the difference is between the inquiry that I am announcing today and what he said should happen in a second stage Francis report, and I must tell him that there are a number of very serious differences. First, this is an inquiry not under the National Health Service Act 2006 but under the Inquiries Act 2005, so there will be a presumption that hearings will be held in public, and that records of evidence and information given to the inquiry must be made available to the public.
In addition, there will be a power of compulsion in respect of witnesses and evidence. I simply do not accept his assertion that had there been a different legal basis for the earlier inquiry people would not have come forward to give evidence. Either they would have done so or, if they had not been willing to do so, they could have been compelled to do so; that power will be available now. This inquiry will have a power to take evidence on oath and a power under the 2005 Act to make recommendations, if Robert Francis so concludes, concerning not only NHS organisations, which are covered by the 2006 Act, but non-NHS organisations. The terms of reference make it clear that Robert Francis will be able to look more widely. The inquiry will examine, for example, the actions of the coroner and the Health and Safety Executive. Indeed, he will be able to make recommendations in relation to the General Medical Council. He would not have been empowered to do that in an inquiry simply under the 2006 Act.
Finally, may I deal with the right hon. Gentleman’s point about targets? The four-hour target is not a measure of outcome; it is not a measure of the result for patients. The result for patients is about their going to an emergency department and their disease, injury or illness being treated successfully. What happened at Stafford hospital provided evidence—we saw other such evidence in many other places—to suggest that the four-hour target was being pursued not in order to give the best possible care to patients, but in spite of what would be the best possible care for patients. Patients were being discharged when they should not have been, and patients were being transferred to inappropriate wards where there was no provision to look after them.
It is vital that we focus on the result for patients. Like me, the right hon. Gentleman knows that the length of wait in the emergency department is not an irrelevant fact for patients. We are therefore going to consider, constructively, how to scrap the four-hour target as it currently exists, and, as my right hon. Friend the Prime Minister said at Prime Minister’s questions, work on the basis of saying that what the clinical evidence makes clear directly contributes to delivering the best possible results for patients. We will start that process soon, in making that clear to the NHS. Our approach will go beyond the simple question of how long people wait in an emergency department; it will go to the outcomes being achieved in those departments. That is what putting quality at the heart of the NHS actually means; it means quality and results, not just processes.
Jeremy Lefroy (Stafford) (Con)
I am most grateful to my right hon. Friend for his statement and for the announcement of an inquiry under the 2005 Act. I am also grateful to him and to the Prime Minister for their support for my constituents over the extremely difficult past year. The Secretary of State will recall that I have written to him on a number of matters in connection with this case, but I should like to raise just one now. Can he assure me that the resources needed both for the inquiry itself and for staff cover will be made available to the trust, so that staff can continue the vital work of restoring public confidence in Stafford hospital?
Mr Lansley
I am grateful to my hon. Friend for that question. Although he has only recently arrived in this House to represent his constituents, I know from my personal experience of our conversations, our meetings and my visits to see him and others in Stafford just how diligently and consistently, and in what a compelling way, he has represented his constituents over the past year or so. In reply to his question, I can tell him that although I have made it clear to Robert Francis that we must do this swiftly—and, therefore, without incurring excessive costs—we must do it successfully and achieve a quality result in order to inform everything we need to do to improve the NHS. We need to go beyond the mere structures and the processes—we have seen all that—to find out why people in all those structures were not focusing on patient safety and quality of care, and how they can be better incentivised, encouraged and required to do that in future. I am sure that my hon. Friend knows that we are ensuring that the additional costs that the Mid Staffordshire trust has had to meet in the course of the first Francis inquiry and now, and in supporting the delivery of better care, are being met with additional resources from the strategic health authority.
Joan Walley (Stoke-on-Trent North) (Lab)
May I, on behalf of constituents whose families were affected by what happened at Mid Staffs, welcome the continued focus that the new coalition Government are placing on making progress on this issue and on ensuring that what happened before never happens again at Stafford hospital? I pay tribute to the work done by my former colleague David Kidney, who, along with the action group, called for a full public inquiry into this matter; that needs to be put on the record. Will the Secretary of State give me assurances about the make-up of the panel, and perhaps give consideration to making trade union representatives members of it? We need to ensure that all people affected in the provision of care can be properly represented and can be part of that panel in the further inquiry.
Mr Lansley
I am grateful to the hon. Lady for her support for the further inquiry. I should say, first, that I share her view that David Kidney sought to get to the bottom of what happened at his local hospital, and pressed for a further, and public, inquiry. The shadow Secretary of State must know that at the beginning of last September Robert Francis came to him in the midst of his first inquiry to raise the issue of the legal base for that inquiry and the question of whether it should be brought under the Inquiries Act. He wanted the terms of reference to be extended sufficiently widely to ensure that at that stage he could have looked beyond the question of what happened, to the question of why the primary care trust, the strategic health authority, the NHS in general, and other organisations, did not intervene earlier and in a better way. On 10 September last year, the then Secretary of State did not agree that that should happen, but had he done so the first Francis inquiry could have achieved much earlier what the second will now have to do.
Mr Speaker
Although we heard about four questions there, I am sure that the Secretary of State will content himself with one reply.
Mr Lansley
If I may, Mr Speaker, I shall content myself with saying that my hon. Friend made it clear from the outset that an Inquiries Act inquiry was the right idea. He said that more than a year ago, and had we gone down that route then, we would have been much further towards getting to the whole truth now. Matters relating to the Inquiries Act and the panel membership are ones that will now be determined by Robert Francis. I have published the terms of reference to which he will be working, and under the Inquiries Act issues such as legal representation and its funding are determined under those.
Robert Flello (Stoke-on-Trent South) (Lab)
My constituents who were affected will also be following very carefully what happens in this public inquiry, and I associate myself with what has been said about David Kidney, who worked extremely hard and effectively on this horrific issue.
I am concerned that the horrific failure at this hospital is being used as a hook in a most appalling way for the proposals to scrap targets, which the Conservatives have talked about for a long time. In any system there will always be people who try to manipulate it; in a culture of fear and bullying, as there was in this hospital, that is exactly when systems will be manipulated. Will the right hon. Gentleman therefore take into account as wide a spectrum of advice as possible when he is considering the new outcome proposals, to ensure that whatever system he brings in is not also open to abuse and manipulation?
Mr Lansley
One of the hon. Gentleman’s friends says that we should take action on the basis of the first Francis inquiry, and we will, and the hon. Gentleman says that we should not take action on targets. The first Francis report made it clear that targets compromise patient care, so we do need to take action.
The hon. Gentleman asked a further question. Robert Francis and I have had two discussions and the terms of reference are very clear. He is looking beyond the structures and processes to how the culture of bullying, fear and secrecy came to pass, what effect it had and how we can move beyond that. The report will be very important, if it is successful, not just for the people of Staffordshire but right across the country in showing how we can move from a top-down, secretive, bullying culture to one that is absolutely open, transparent, focused on patient safety and entirely responsive to the needs of patients.
Mr Aidan Burley (Cannock Chase) (Con)
One of the tragedies is that concerns were being raised about Stafford hospital as long as five years ago but little or no notice was taken of them. A constituent of mine, Barbara Allatt, was until recently a student nurse who helped to expose the appalling neglect of elderly patients at the hospital trust, but rather than her concerns being acted on, she was instead needlessly thrown off her training course. In his statement, the Secretary of State outlined new whistleblowing rights for future staff. Will those rights be extended retrospectively so that staff who spoke out previously, and in doing so put their job at risk, will not be punished again?
Mr Lansley
Of course, by definition, contractual rights cannot be retrospectively applied, but let me make it clear that I will be issuing guidance in terms that I have set out to the House in my statement today—albeit that we might need to do more. That guidance is entirely intended to move the NHS to an open culture that encourages staff to raise concerns. As I said to the Patients Association yesterday, we must have a culture of challenge inside the NHS under which the offence is not to make a mistake, as mistakes are human, but to seek to cover up or ignore a mistake. That is what happens in the best organisations and it must be what happens throughout the NHS.
Steve McCabe (Birmingham, Selly Oak) (Lab)
I welcome the Secretary of State’s promise of early action. Will he tell us how many members of the present board were in post on 18 March 2009 and when he will sack them as he has promised?
Mr Lansley
The hon. Gentleman will forgive me: I know that the chief executive, the chair, the nursing director and others have moved on, but I do not know the precise answer and I will write to him about that. In relation to any individuals, I think it is proper that, having asked Robert Francis to conduct a further inquiry that takes account of all that he discovered in the first report and that covers the same period of time—2005 to 2009—he is free to make recommendations that will bear upon people working inside the trust and in organisations, and upon how they discharge those responsibilities.
Gavin Williamson (South Staffordshire) (Con)
I thank my right hon. Friend for announcing the inquiry, which will be welcomed by many of my constituents and others. I urge the Department of Health always to listen to the relatives of patients, because relatives were saying that this was a problem far earlier than anyone else. Will the Secretary of State, please, always listen to what relatives and patients say?
Mr Lansley
I am glad that my hon. Friend raises this point, because I know from the four occasions on which I have visited Stafford and talked to members of the Cure the NHS group just what a desperate struggle they had to be listened to. We should therefore be clear not only about changing the culture inside the NHS, so that patients’ issues and complaints are treated seriously from the outset in an open and transparent way, but that the patient voice should be strengthened in the NHS. Even people who are literally self-appointed voices for patients should not be dismissed and pushed to the margins. We have to be prepared to listen to patients however their views are brought forward.
Mr Dave Watts (St Helens North) (Lab)
The Secretary of State was unclear about his proposals for waiting times. Will he clarify this issue? He seems to be saying that he will do away with waiting times but then introduce a new system. Will the new waiting time be four hours, five hours, six hours, 10 hours or 12 hours?
Mr Lansley
I am afraid that the hon. Gentleman does not seem to understand. I was very clear in saying that I am going to abolish the four-hour accident and emergency target. I will issue guidance to the NHS shortly, the purpose of which is to amend the four-hour A and E target, alongside others, to ensure that we deliver better quality. That is not just about the time spent waiting in an emergency department; it is about the quality of the service provided and it is based on clinical evidence.
Mr Lansley
The point that I am making is very clear. We are not going to focus on narrow process targets in future; we are going to look at the quality and outcomes provided for patients. I will issue future guidance on that.
Nadine Dorries (Mid Bedfordshire) (Con)
The report highlights that there was a breakdown of care at almost every level, from basic nursing care up to high levels of communication. Does the Secretary of State agree that when the patient becomes the absolute focus of every level of care delivery, from basic levels of nursing care right up to top levels of management, it will be more difficult for such a culture to grow in terms of process delivery? Will he guarantee that the report will look at putting back into hospitals the approach of making the patient the most important person and of putting the patient at the centre of every element of care that is delivered?
Mr Lansley
Yes; my hon. Friend is absolutely right. That is why I have made it clear that that is the first priority for our Department in how we are going to improve the NHS. As a nurse, my hon. Friend will know that what she describes is absolutely how many people across the NHS want to conduct their professional relationships. They have been so frustrated, demoralised and demotivated by not being able to deliver care in the way that they wish—focusing on the needs and expectations of patients.
Mr Stephen Dorrell (Charnwood) (Con)
Is not the important issue that the terrible events in Mid Staffordshire are not purely a local issue, terrible though they are for Mid Staffordshire? It is vital that lessons are learned for application right across the NHS. What were the commissioners doing? Where were the regulators? What price professional accountability? Why was all that allowed to happen over so long? Perhaps the most difficult question of all is this: why was it not the first time that this had happened in the NHS?
Mr Lansley
My right hon. Friend is absolutely right. That is why we have to move from all those questions to some serious answers—so that we can have the reform that the NHS so badly needs. I know and he knows that this is about not just a different set of structures, but a change of culture and a focus in the NHS on patients and results for patients to the exclusion of other bureaucratic impositions. There is such immense bureaucracy—PCTs, SHAs and regulators—that everything should have worked perfectly, but it did not. Why? Because in all of that, the underlying pressures in the service were not focused on results for patients. We have to drive towards that conclusion.
Siobhain McDonagh (Mitcham and Morden) (Lab)
Will the Secretary of State give way?
Heather Wheeler (South Derbyshire) (Con)
I welcome my right hon. Friend’s statement. Only yesterday, I wrote to him regarding a constituent in South Derbyshire who had gone through a four-hour wait and was then admitted, to make sure that the four-hour rule was not broken, and had to stay in a ward for six hours and see even more people when he could have been on a bus going home much earlier. There are lessons to be learned across the whole country, and I look forward to the report coming through.
Mr Lansley
I am grateful to my hon. Friend. We will take not only the clear evidence from the first Francis report, but evidence from many other places, including that from many of the leading clinical professions that the way in which the four-hour target has been administered has undermined the quality of patient care. We will focus on quality and help the NHS to deliver what it knows is the right quality.
Harriett Baldwin (West Worcestershire) (Con)
I welcome my right hon. Friend to his post and thank him for his two visits to Malvern over the past few years to support the new community hospital that will open in October.
My right hon. Friend mentioned the West Midlands strategic health authority. In the past six months, the authority has required our local Worcestershire NHS to divest itself of its community hospitals. At the moment, the authority is proposing to abolish the mental health trust and put it and the community hospitals into a new trust. Secondly, it has asked NHS Worcestershire to cluster with neighbouring NHS organisations. What are my right hon. Friend’s proposals to stop all those reorganisations and focus on patient outcomes?
Mr Lansley
The inquiry will look at both the West Midlands SHA and its predecessor bodies. My hon. Friend will know from what I said a couple of weeks ago that proposals for such reconfigurations in the national health service must now answer to the clinical evidence—the clinical base. They must answer to patients—current and prospective patient choice—and to the referral intentions and commissioning intentions of general practitioners exercising responsibility for commissioning. That will change the nature of such decisions from a top-down, unaccountable process to one that is much more locally accountable and effective.
Mr Peter Bone (Wellingborough) (Con)
The excellent new Secretary of State for Health was right to praise the men and women of the health service, but when things go wrong there needs to be an early-warning system. Does he agree that standardised mortality rates are an indication that something might be going wrong, and that such indicators should be used more often to investigate hospitals?
Mr Lansley
I am grateful to my hon. Friend. First, the Francis inquiry will go on to understand why one of those hospital SMRs, from 2003, indicated the nature of a potential problem. The SMRs are not a sufficient measure of quality across the board. The National Quality Board has already undertaken some work on how we can ensure that hospital SMRs are consistent and meaningful, and beyond that how we can identify the early-warning signs and act on them. As one of the things we derive from that, I shall be working with the quality board and across the NHS to ensure that we act on warning signs, including looking at potential risks either across the system or in relation to individual trusts.
Dr Sarah Wollaston (Totnes) (Con)
Will the inquiry cover the sheer volume of bureaucratic paperwork that nursing staff have to complete, which seriously gets in the way of their fulfilling their clinical responsibilities?
Mr Speaker
I am grateful to Members for their co-operation. We have got to everybody.
Time for Training (Medical Education England Report)
Lord Lansley Excerpts(14 years, 6 months ago)
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The Secretary of State for Health (Mr Andrew Lansley)
“Time for Training”, the independent review of the impact of the European working time directive on the quality of medical training is being launched today by Medical Education England. A copy has been placed in the Library and copies are available to hon. Members from the Vote office.
In response to concerns about the impact of the directive on the training of junior doctors working in the national health service, the then Secretary of State asked Medical Education England last year to commission an independent review. I want to thank Professor Sir John Temple for his report and Medical Education England for their advice in helping to bring together complementary perspectives to issues affecting the quality of patient services and training.
The objective of post-graduate medical training is to produce fully qualified specialists who are able to provide high quality and safe patient care. Experience in delivering service is an integral part of training for a junior doctor but the provision of service is not the primary purpose of post-graduate medical training. Sir John’s review challenges the service and medical profession to think afresh about the approach to training the next generation of hospital specialists in ways that will provide better patient care and well-trained professionals.
The findings in this report underline the importance of the coalition agreement commitment to limit the impact of the directive in the context of United Kingdom health services. “Time for Training” identifies ways in which safe care and high-quality training are capable of being achieved in the service. It also highlights the immediate difficulties created for trainees and for the service, especially in providing out-of-hours and weekend emergency patient care, in places where there is not yet the structure, support or flexibility of working practices needed to comply with the directive and the restrictive interpretations of the directive by the European Court of Justice.
I will support my right hon. Friend the Secretary of State for Business, Innovation and Skills in taking a robust approach to future negotiations on the revision of the directive, including maintenance of the opt-out. We will not go back to the past with tired doctors working excessive hours, but the way the directive now applies is clearly unsatisfactory and is causing great problems for health services across Europe. These difficulties are clearly reflected in the evidence from junior doctors that the implementation of the 48-hour week EWTD has impacted adversely on training and has been accompanied by unwelcome imposition of shift practices. Sir John’s report reinforces my determination to support efforts to resolve these difficulties and be ready to work constructively with the European Commission and other member states on radical, creative approaches to gain additional flexibilities.
Professor Sir John Temple’s findings demonstrate that far more can be done now by the service and the medical profession to improve medical training by changing working practices and taking greater advantage of the big increase in the number of consultants working in the national health service. I welcome his recommendations that the New Deal contract for junior doctors should be better aligned with the structures under the directive and that the consultant contract and job planning should incentivise consultants to support trainees and continuity of training. Continuity of patient care, of course, rests with the consultant who is responsible for the patient.
I have asked Medical Education England to consider with the profession, the service and medical Royal Colleges, how best to implement training practices that will support these aspirations. This will include reviewing the appropriate service component for medical specialty training with individual colleges and specialty associations, and advising NHS employers in their discussions on ways to realign and simplify New Deal working arrangements. I will continue to seek advice from Medical Education England on other matters to improve training, including development of a strategy for technology-enhanced learning and take-up of simulation training, and on the future structure of post-graduate medical education.