Francis Report

Alex Cunningham Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

I hope that the Secretary of State was listening to my hon. Friend. The point I was making—he did not like it—was that there is plentiful evidence that the NHS has gone downhill in the 12 months since the publication of the Francis report. The chaos in A and E has increased, and pressure on mental health services has reached almost intolerable levels.

Trusts face great difficulties in recruiting sufficient A and E doctors—a central issue in the Francis report, as it addresses safe staffing numbers.

[Alex Cunningham (Stockton North) (Lab)]

I agree that this is a debate about the whole NHS, and the 111 service is failing people. On Saturday night, I had direct experience of that with my six-month-old grandchild. I phoned the 111 service, but nobody could tell me when I could speak to a doctor. What did I do? I went to A and E.

[Andy Burnham]

That is the problem. The Government’s focus is on hospitals. All the while, alternatives to A and E are being degraded and taken away. It is an undeniable fact that it has become much harder to get a GP appointment under this Government. The Patients Association warns that it may soon be the norm to have to wait for up to a week. [Interruption.] The Secretary of State says, “Nonsense.” He should get out and speak to people. The people I speak to tell me they are getting up in the morning and ringing the surgery at 8 am or 9 am, only to be told there is nothing available for weeks. As my hon. Friend the Member for Stockton North (Alex Cunningham) said, they ring 111 and the advice given is to go to A and E.

The Government have created the situation that the Secretary of State will not address. He wants to put it all in his own terms, but this is the reality in the NHS right now and this is what has happened since the publication of the Francis report. He has put more pressure on hospitals, because he has made it harder for people to get a GP appointment, and hospitals today face greater difficulty in meeting their targets. Indeed, as I just said, in the 12 months since the Francis report, hospital A and Es have missed the target 32 times running. These issues go to the heart of what we are debating today.

--- Later in debate ---

[Alex Cunningham (Stockton North) (Lab)]

Thank you, Mr Deputy Speaker. It is an especial pleasure to follow my near neighbour in the north-east of England, my hon. Friend the Member for Easington (Grahame M. Morris), and I agree with everything he said. I was particularly interested in his reference to the reduction in tariff costs, which made me think about the new hospital we were planning to replace the Hartlepool and North Tees hospitals. That is yet to be delivered, despite its being crucial to health care in the area we both represent. I am hoping that we may soon hear from the Government that they are going to approve the assistance we need to deliver it, which will help us cope in that part of the world with the reduction in the actual tariffs.

Our national health service is for millions one of the world’s success stories of the second half of the 20th century, with teams of dedicated people—from porters and reception staff to nurses and consultants—who have risen to the challenge of change and innovated to do the best for our people. As a result, the NHS has survived and largely prospered despite the often unnecessary burden and restrictions placed on it by Government.

I am pleased to have learnt this afternoon that the future of the health service is in good hands: during this debate, I heard from my great niece, Meghan Quarne, who has just managed to secure a place at the Edinburgh medical school, so I am one very proud great-uncle this afternoon.

Yes, the NHS has been a success story, but there have been many failings that have devastated families, health professionals and politicians. We must never minimise the impact of failures that have occurred under different Governments at, for example, Bristol, Alder Hey and Mid Staffs. We must take action to ensure that we improve what we do in the NHS.

I also recognise that a number of trusts have been placed in so-called special measures. That is good not because of the things that are going wrong, but something is being done about the problems so I look forward to seeing the improvements that we all desire.

Of course it does no one any credit to play the political blame game. Members from current and previous Governments must recognise that things do go wrong, sometimes badly, and that everyone should work co-operatively to drive the improvements that we all want. That said, we must also recognise that the NHS is still a success story. It is treating more people with more complex conditions as well as the routine ones. However, the Francis report exposed an organisational subculture within parts of the NHS that was guilty of persistently compromising patient safety, jeopardising the quality of care and tarnishing the experience of the NHS as a first-class health care system.

In the most extreme examples, the failings identified in the Francis report have resulted in patients dying needlessly owing to dehydration and exposure—yes, severe neglect. It is unquestionable that such deficiencies resulted in suffering being needlessly caused to large numbers of patients. The report highlighted a wide-ranging and complex mix of failings, which included a board that was more focused on finance than on the quality of care received by patients; chronic understaffing that impacted on the ability to provide the care required; and a culture of poor practice and neglect that many staff felt powerless to challenge.

There can be no doubt that the situation was utterly abhorrent and should never have been allowed to arise, let alone be repeated. The NHS Confederation was candid, but accurate, in describing the failings at Mid Staffordshire as

“a nadir for the health service.”

In short, there are lessons to be learned from the ordeal—lessons that need to be learned quickly and thoroughly. The recommendations made by the Francis report some 13 months ago were therefore squarely aimed at addressing and improving that frame of mind within trusts through increased levels of transparency and by placing greater focus on the quality of care being delivered.

Although it is important that we recognise that genuine culture change is a slow and evolutionary process that could take time, particularly when some of the changes in question are centred on sensitive issues such as the ability to raise concerns, it cannot be an excuse for risking further neglecting patients by failing fully to address each of the core concerns that were identified.

It is therefore disappointing that the Government have taken an inconsistent, scattergun approach to the report’s findings, ploughing ahead with a damaging top-down reorganisation of the NHS, cutting thousands of nurses and delivering a crisis in A and E. That course of action is destined to weaken and destabilise the NHS, not remedy the problems that have already been diagnosed. It must be a matter of concern that the recommendations that Francis made appear to be some considerable way off becoming a reality.

With the health service’s resources being limited in the face of rising demand for health care, coupled with an increasingly complex system of commissioning services that can involve many layers of bureaucracy and administration, it is more important than ever that the Government acknowledge the limitations that exist to transforming the culture of the NHS through legislation alone.

Although the Government accepted the report’s recommendation to introduce a duty of candour to organisations, they rejected the recommendation to extend that duty to individuals. My hon. Friend the Member for Easington mentioned that earlier. However, those individuals—the leaders and professionals in the NHS—are central to transforming care.

All parts of the NHS—from the ward to the board—have a role to play in creating a more open and honest health service. Every member of staff, regardless of role or seniority, should therefore see providing dignified, compassionate care to all patients as central to their duty. The vast majority of them do so, but I am still apprehensive because an organisational duty alone will not help individuals challenge an organisation with a dysfunctional culture. A simple duty on an employer will not encourage employees to come forward if they are not already motivated to do so by a professional code of conduct.

It is worth noting that an inherent tension remains between prioritising the quality of care delivered to patients and pushing the importance of financial performance. This is particularly true if increasing front-line staff numbers is viewed as the main route to improving safety and quality at the expense of an unnecessary and complicated reconfiguration of care pathways and services.

The Francis report identified one of the root causes of the terrible failures at Mid Staffordshire as a fundamental lack of staff, and many people have talked about that. Although some of the failings were the result of unprofessional behaviour on the part of individuals, the factor overwhelmingly responsible for many of the failings was a lack of staff. Yet, despite this finding, there are now thousands fewer nurses and front-line staff in the NHS than in 2010, with 7,000 front-line staff being made redundant between 2010 and 2013.

Achieving the excellent results and care that patients demand and deserve is dependent on a number of factors, and adequate staffing is certainly central to achieving that goal. However, excellent care requires not only the appropriate number of staff but, importantly, staff with the correct mix of skills. Those skills include a range of factors, including leadership, staff engagement and appraisal.

Although I appreciate the attraction of nationally set minimum ratios of nurses to patients, it is important that we recognise that this is an over-simplification that does not necessarily represent the safest way forward. Not only would a minimum staffing level remove the flexibility required to meet the changing needs of patients, but a nationally set minimum would run the risk of being seen to constitute a ceiling rather than a floor. Instead, appropriate staffing and the best mix of skills are perhaps best determined locally, based on robust evidence and local circumstances.

I well remember that, when I was a non-executive director of the North Tees and Hartlepool NHS Foundation Trust, we had a fantastic chief nurse—her name was Smith—who led a tremendous team. She inspected the wards. She took a team of people on to the wards. They talked to the patients. They looked under the beds. They dragged their hands across the top of the wardrobe units to test their cleanliness. They did a full and thorough check. They talked to the staff. They put nurses at the centre of patient care—something that is absolutely critical today.

Although there has been a small increase in the number of hospital-based nurses in the past year, a paper from the NHS regulator, Monitor, analysing foundation trusts’ plans for 2013 to 2016, shows how temporary increases in nurse numbers this year, 2013-14, will be outweighed by larger cuts to nurse numbers over the next two years. Indeed, the paper suggests that hospitals are planning to “significantly reduce nurses” from next April and that the temporary rise this year is just

“a short term fix for operational pressures”.

Specifically, the analysis shows that, although trusts are planning to increase nurse numbers by 2% this year—around 3,400—that will be followed by 4% cuts in 2014-15 and around 6,900 will go the year after.

There has never been any excuse for neglect by nursing staff. There has never been any excuse for what happened at Mid Staffs. But if, as Francis said, a lack of staff was fundamental to the Mid Staffs failure, that is surely the central lesson for us all, including the Government, to learn.