Accountability and Transparency in the NHS

Aidan Burley Excerpts

Thursday 14th March 2013 Commons Chamber

[Andy Burnham]

No, I am making some progress.

The second area where more transparency and accountability is urgently needed is on staffing levels. If the Government are not yet able to commit to all the recommendations, I ask them to expedite their response to Robert Francis’s important recommendation on patient-staff ratios. The board of Mid Staffs embarked on a dangerous programme of staff cuts, and yet public and staff representatives had no outside guidance to challenge it. The chief nursing officer said yesterday that staffing should be a local decision. Surely the lesson of Mid Staffs is that there is a need for much clearer national standards and guidelines, as suggested by the Francis report?

This week, the Care Quality Commission reported that one in 10 hospitals in England and, worse, one in five learning disability and mental health services do not have adequate staffing levels. Surely that should ring alarm bells in the Department as it suggests that parts of the NHS are already forgetting the lessons of the recent past.

The third area on which we need a clear statement from the Government today is the accountability and transparency of all organisations providing NHS services. Under “any qualified provider”, the Government are persisting with their assumption that all NHS contracts should be open to full competitive tender. Despite a promise to rewrite the section 75 regulations that are being made under the 2012 Act, my reading of the rewritten regulations is that regulation 5 will not let doctors decide, but will in effect force clinical commissioning groups to open tender for contracts. That raises the prospect that there will be a significant increase in the coming years in the number of private and voluntary sector organisations providing NHS services.

If we believe in transparency and accountability, surely they have to apply across the board and on a level playing field. The problem is that private and voluntary sector organisations are not subject to the same strictures on freedom of information and whistleblowing. If action is not taken, we face the prospect of a serious reduction in transparency and accountability. Our attempts to find out new information under FOI requests on providers selected under AQP have hit the brick wall of “commercial confidentiality”. I say to the Secretary of State that that is not good enough. Accountability and transparency must always be paramount, as the motion says.

Will the Secretary of State require all providers of NHS services to adhere to FOI principles, and will he ensure that whistleblowers working in organisations that provide NHS services have the legal protections that he has announced today? I draw the attention of the Secretary of State to an early-day motion tabled by my hon. Friend the Member for Easington (Grahame M. Morris) on this subject, which has attracted the support of 109 Members.

The fourth area on which the people of Stafford need openness and transparency is the future of their hospital. They will understandably be worried about the recent recommendation from Monitor that the trust should be placed into administration. People will recall, as I said to the hon. Member for Stone (Mr Cash) a moment ago, that I commissioned Robert Francis in July 2009 to conduct an independent inquiry. I know that many people, including the hon. Gentleman, wanted me to go further and order a full public inquiry, but I stopped short because I was concerned about the effect that that would have on the hospital and its viability.

All of us in this House now have a responsibility to help this hospital heal. After all that they have been through, it would be highly unfair to the people of Stafford if, at the end of all this, they were to lose their hospital or their A and E. They deserve a safe and sustainable hospital and I hope that the Secretary of State’s response to Monitor’s recommendation will map out a way to achieve that.

[Mr Aidan Burley (Cannock Chase) (Con)]

rose—

[Nick de Bois (Enfield North) (Con)]

rose—

[Andy Burnham]

I will give way one final time—to the hon. Member for Cannock Chase (Mr Burley).

[Mr Burley]

I represent the other constituency that is served by Mid Staffordshire NHS Foundation Trust. Is the right hon. Gentleman implying that it is the holding of a public inquiry that has led to the threat to Stafford and Cannock Chase hospitals?

[Andy Burnham]

No, that is not what I am saying. I commissioned a second-stage—[Interruption.] The hon. Member for Cannock Chase should listen to the answer. I commissioned a second-stage review before the general election after Robert Francis delivered his first-stage review to me. I simply said that I took that judgment because I was worried that if there was ongoing uncertainty about the hospital for a long period, it may affect its viability. I have seen the statements from Monitor that there is a concern about the future viability of the hospital. I am making an appeal, on a cross-party basis, to say that all of us owe the people of Stafford a safe and sustainable hospital. I hope that the hon. Gentleman would agree with that sentiment.

My fifth and final point concerns staff morale.

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[Mr Aidan Burley (Cannock Chase) (Con)]

May I thank the right hon. Member for Cynon Valley (Ann Clwyd) and say how sobering it was to listen to those stories? I join my hon. Friend the Member for Stafford (Jeremy Lefroy) in paying tribute to the families and loved ones of patients from Stafford and Cannock who had such appalling care and praise them for their strength in telling their stories. My hon. Friend and I will fight against any serious downgrading of Stafford hospital and, more importantly, from my perspective, any possible closure of Cannock hospital, which is managed by the same trust. I note that the Staffordshire Newsletter today launched its “Support Stafford Hospital” campaign, which I am sure we will both be supporting.

Today’s motion calls for accountability and transparency in the NHS. In relation to Mid Staffordshire NHS Foundation Trust, there are three areas that most need accountability and transparency: the granting of foundation trust status in 2009; the opposition to the public inquiry into what went on; and the “targets at all costs” culture. I will deal with each in turn.

We have the indignity and embarrassment of Mid Staffordshire NHS Foundation Trust being abolished by Monitor only five years after being granted that status. I want Members to think about that for a second. Only five years ago it was considered so outstanding and such an exemplar of compassionate care and sound finances that the right hon. Member for Leigh (Andy Burnham) awarded it foundation trust status on 1 February 2008.

[Andy Burnham]

May I just correct the hon. Gentleman? I was not a Minister in the Department of Health on 1 February 2008. Furthermore, the awarding of foundation trust status was the responsibility of Monitor, not Ministers in the Department.

[Mr Burley]

I believe that the right hon. Gentleman’s second point is incorrect; as I understand it, the Secretary of State—I accept that that was the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson)—signs off the awarding of foundation trust status. We know that he admitted to the public inquiry that he looked at just four lines of civil service evidence about foundation trust status before signing it off. Is that good enough for a Secretary of State? Why did he not look at it in more detail? Was he not really bothered? I think that was a dereliction of his duty to ensure public health in Staffordshire and that he should have the decency to apologise to the people in the Public Gallery who have come here today from my constituency and that of my hon. Friend the Member for Stafford.

Alternatively, was the foundation trust status signed off because of the culture of targets at any cost under the previous Government? Was organisational form, whatever it means, more important than patient care? We know locally that they wanted to prove that their foundation trust policy was a success, and that took priority over what it really meant for patients and their care. Members do not have to listen only to me on that point. Here is what a Mid Staffordshire NHS Foundation Trust non-executive said just this week in a public meeting in Rugeley in my constituency:

“Our problems started when they made 200 nurses redundant in 2008 to achieve an acceptable financial footing for Foundation status, but care standards slipped thereafter and by 2009 they had a £2m deficit.”

Everyone knows that huge pressure was put on David Nicholson by his political masters to have a foundation trust in the west midlands, and poor little Mid Staffordshire was the one that was forced through. In the interests of the accountability and transparency that the motion calls for, I want to hear an apology from those who forced through foundation trust status at a time when people were dying from appalling care and the trust was going bankrupt.

This is not just about politicians. If anybody is in any doubt about how ingrained the targets culture had become, let me quote from an old press release from Mid Staffordshire trust that I found, dated 3 October 2002. It has been taken off its website but is still findable if one looks around on the internet. It says, under the heading, “Babies’ Service of Remembrance”:

“A short service of Remembrance for those whose babies have died in the past few years is being held in the Pilgrim Chapel at Stafford General Hospital.”

Just seven days later, under the heading, “Good News from Mid Staffordshire General Hospitals NHS Trust”, it said that David O’Neill, the chief executive, was

“delighted to announce that the Trust has been short-listed to the last three for the National Partnership Industry Award for our Bed Management System”.

This culture is absolutely astonishing, and it simply has to change.

We have now had the public inquiry and Robert Francis has laid out in full gory detail the horrendous failings at Stafford hospital. One might have thought, given what went wrong, that there would have been cross-party support for a public inquiry, but not so. I presume that Labour Members now support the findings of the Francis inquiry. There were certainly many Labour MPs at the all-party health group meeting with Robert Francis on Tuesday, but I want to know how many of them were among the 260 Labour MPs who voted against a Commons motion calling for a public inquiry on 18 May 2009. [Interruption.] These might be uncomfortable facts for the right hon. Member for Kingston upon Hull West and Hessle, but let me point out that Labour Members ignored 81 requests for a full public inquiry into Mid Staffs between January 2009 and May 2010. They received 20 letters from MPs, 36 letters from members of the public and 25 letters from organisations. They ignored the families who protested outside the Department of Health for a public inquiry, including people from Cure the NHS.

The right hon. Member for Leigh, as he has said today, rejected a full public inquiry on the grounds that it would “distract the management”. He is welcome to intervene to tell me whether he now accepts that that judgment was wrong.

[Andy Burnham]

Will the hon. Gentleman acknowledge that I asked Robert Francis to conduct two independent inquiries into what happened? It is not the case that I was not doing anything. I made that judgment because I wanted to get to the truth of what happened while not overburdening the hospital with the job of getting better. I tried to strike that balance, and that is why I reached the judgment that I did.

[Mr Burley]

I will accept, as will, I think, everyone in this House, that the right hon. Gentleman has refused to answer the question again. He will not say whether that judgment was a mistake, and until he does so we cannot take what he says seriously.

The then Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle, joined in the refusal to have a full public inquiry. He said to The Birmingham Post on 19 March 2009,

“I really don’t think with the greatest respect that a public inquiry is going to take us any further forward”.

Will he intervene to tell me whether he will be writing to The Birmingham Post to tell people whether it has taken us any further forward? He can scowl across the Chamber, but I am afraid that that is no answer.

In the interests of accountability and transparency, we need to know why the Labour Government opposed a full public inquiry into Mid Staffordshire. Why were they so afraid of finding out the truth of what went on? Is it really so important to protect the reputation of the NHS as an institution rather than to protect the patients whom it serves and who ultimately pay for it?

There are now abounding claims and counter-claims about Stafford and Cannock hospitals as a result of the indignity of having our foundation trust abolished. One would have thought that having forced through foundation trust status and opposed a public inquiry, Labour locally would have some contrition, but sadly not. The Labour leader of my local council and Labour’s prospective parliamentary candidate for Cannock Chase are now teaming up to

“fight plans they feel are aimed at privatising Cannock hospital.”

The leader of the council said that he was launching a petition against being

“victims of Tory privatisation plans”.

There are no plans in the Monitor report to privatise Cannock hospital, so I want to know where the local Labour party is getting its information from. In fact, as a result of the FT status, private providers are already operating in Cannock hospital. I note that there were no protests from Labour councillors when private health facilities were introduced into Cannock hospital. Again in the interests of accountability and transparency in the NHS, I call on Labour Front Benchers to stop their parliamentary candidates and council leaders scaremongering among local people for political ends. They cannot fight privatisation if there are no plans to privatise anything. They cannot start a petition to save Cannock Chase hospital if the Monitor report suggests making it a centre of excellence for orthopaedic elective surgery in the west midlands. They cannot oppose a public inquiry and then welcome all of its findings. They cannot force through foundation trust status for its own sake rather than for what it will achieve for patients; and if someone does force it through and it has the reverse, perverse effect of causing appalling care, unnecessary deaths and the bankrupting of the trust and its abolishment just five years later, they should be man enough to apologise.

I agree that we need to be more accountable and transparent. That starts from the top with Secretaries of State and goes down to the bottom to the local council leaders and their parliamentary candidates.

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[Stephen Barclay]

I do agree with my hon. Friend, and that does seem at odds with the Government’s welcome commitment to promoting individual accountability. In response to the Robert Francis report, the Prime Minister talked about three fundamental problems with the culture of the NHS. Of course that went beyond one individual.

I am concerned about the timing of the announcement of the appointment of Barbara Hakin, a close ally of Sir David Nicholson. It is important to note that she is innocent of any allegations being made against her, but I understand that she is under investigation at the moment. The timing of the appointment, then, seems strange. I invite my right hon. Friend the Secretary of State to intervene to clarify whether he was told of Barbara Hakin’s appointment prior to it being made. If he was not told, does not that say something about the power that Sir David wields within Richmond House?.

A further issue is whether Parliament knows the quantum or scale of the payments made to whistleblowers. I have repeatedly raised this matter over the last two years and was finally given a figure of £15 million paid over three years—silencing quite a lot of people. It now emerges, however, that that is not the whole story, as it does not cover payments such as the one for Gary Walker, which was paid through judicial mediation.

As seen in the NHS manual for accounts, each NHS body or trust is required to compile a register detailing all special payments made, including those through mediation. As I understand it, even the Department of Health does not know how many such payments have been made—and that applies to the Treasury, too. In a response to my parliamentary question this Tuesday, the Minister said:

“Approval has not hitherto been required by the Chancellor or the Secretary of State for Health for special severance payments made as a result of judicial mediation. However, as of 11 March”—

this Monday—

“approval will be required.”—[Official Report, 12 March 2013; Vol. 560, c. 182W.]

The position seems to be moving as of this week. Parliament does not know how much has been paid to whistleblowers, so will the Minister clarify when we will know?

In my Adjournment debate of a week last Monday, my hon. Friend the Member for Bracknell (Dr Lee) asked whether the chief executive of Mid Staffs was subject to a gagging clause. We received a welcome reassurance that we would be given an answer, but when we were on our way to the Chamber for this debate, my hon. Friend told me that he had received none. I hope that the Minister will clarify whether Mr Yeates was subject to a gagging clause.

[Mr Burley]

Is my hon. Friend aware that Mr Yeates left in 2009 with an £80,000 pay-off and a six-figure pension lump sum before moving to a job with a charity called IMPACT Alcohol and Addition Services, based in Shropshire, and that he refused to give oral evidence to the inquiry because of a unique form of post-traumatic stress disorder? Where is his accountability?

[Stephen Barclay]

My hon. Friend is right. Not only did Mr Yeates leave with, I understand, a significant payout, but he went to work for a charity that was in receipt of Department of Health funds. I think that as a matter of urgency we should clarify the terms on which Mr Yeates left the NHS, what Ministers knew, and what senior officials—in particular, David Flory—were aware of at the time of his departure.

I fear that we are in danger of sending a confused message to staff and families of patients in the NHS. On the one hand we say that the culture needs to change, but on the other we say that the people who are responsible for that culture—the people who are paid significant sums to lead it—should stay.

My hon. Friend the Member for Totnes (Dr Wollaston) is absolutely right: there is much in our NHS that we should celebrate and of which we should be proud. However, we do it a disservice if we are not prepared to identify where it is going wrong, and to be transparent about the areas with high mortality and about the existing culture which has a chilling effect on those who are brave enough to speak out. Is it not informative that the one person who spoke out at the Bristol inquiry, and who did so much good, is the one person who has never worked in the NHS again?

I think that the challenge for the House today, and in subsequent weeks, is to ensure that this time it learns the lessons that were clearly not learnt then.