Care Quality Commission (Morecambe Bay Hospitals)

Andy Burnham Excerpts

Wednesday 19th June 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for early sight of it, and I welcome what he has just said. Today’s report will have left people stunned. The Secretary of State began with an apology and we on the Opposition side echo it. It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What is never acceptable is when people or organisations try to hide those mistakes. As Professor Sir Liam Donaldson, the former chief medical officer, says:

“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Sadly, that is precisely what appears to have happened in this case.

The report covers a four-year period from autumn 2008 to autumn 2012. It details failures in regulation, but also subsequent attempts at a cover-up. It was published only because of the efforts of James Titcombe and his family. Like the Secretary of State, I pay tribute to them today, as does my hon. Friend the Member for Barrow and Furness (John Woodcock), who has supported the family. As he rightly said, that family’s suffering has been intensified by the actions of the NHS—something that should never happen. It is now essential that they and all the other Cumbria and Lancashire families affected get all the answers they are looking for—and I fully commit the Opposition to making sure that happens.

The most shocking revelation in this report is that, in March 2012, an instruction was given by a member of senior management at the CQC to “delete” the findings of a critical internal review. Let me remind the House of the context in which that March 2012 instruction was given. At that time, we were midway through a major public inquiry into the terrible failings at Mid Staffs. This was two years after the completion of an earlier independent inquiry—also led by Robert Francis, QC—following which all parts of the NHS had committed to full openness and transparency. It also came after failings at other trusts—most notably Basildon and Thurrock—which led me to request an in-depth look at all hospitals so that problems could be flushed out and a system put in place to ensure that people had a comprehensive picture of local standards. That was the context in which this instruction was given, and it explains why today’s revelations beggar belief and are hard to comprehend. The report raises questions for the CQC and the Department; I will take each in turn.

The new chief executive, David Behan, commissioned this report and we pay tribute to him for doing so. The chair has said today that he now wants to draw a line under this issue, but does the Secretary of State agree that it will be possible to do that only when further questions raised by this report are answered?

On hospital regulation, there is a recognition on all sides that it has not been good enough for too long. While we note the important work of Don Berwick, should we not also be getting on with the job of implementing the recommendations of the three-year Francis report in this regard? The Secretary of State mentioned a duty of candour on providers, but he will know that Robert Francis recommended that that should extend to individual clinicians, too. Will the right hon. Gentleman work with the Opposition to implement that recommendation as soon as possible?

On the cover-up, paragraph 1.17 of today’s report says that the order to delete

“may constitute a broader and on-going cover-up.”

Will the Secretary of State address that point directly and tell the House whether he is confident that this cover-up is no longer happening? Is he satisfied that the CQC has taken all appropriate steps, and does he have full confidence in it going forward, or does he believe a further process of investigation is necessary?

More specifically, is anybody who was involved in the decision to delete still working at the CQC or elsewhere in the NHS? If they are, people will find that hard to accept and they will want answers on that specific point. Given that accountability is essential, does the Secretary of State agree that people will find it hard to accept if data protection laws stand in the way of that accountability, and will he therefore review the decision to shield the identities of those involved? Today’s report makes it clear that the “deleted” report still exists. Should it not now be published?

Now let me turn to the Department of Health. Was the decision to delete taken solely by senior management at the CQC or is there evidence that anyone outside the CQC was either involved in the decision or aware of it? Was anyone in the Department of Health aware of the internal report being produced, and did any contact take place between the CQC and the Department running up to the decision to delete it?

Unfortunately, this matter does not end with deletion of the report. The Prime Minister said earlier that there should always be support for whistleblowers, and he was right, but there are serious doubts about whether that has happened in this case. Concerns about the CQC were raised by an internal whistleblower who was on the board. We know there was an attempt to remove her from the board and to question her character. Has the Secretary of State looked into these issues and considered whether appropriate support was provided—by both the CQC and the Department—to the individual who raised these concerns? The same whistleblower told the CQC today that she had raised issues internally first, then within the Department and then directly with the former Secretary of State in a meeting. Will the Secretary of State provide details of that meeting and publish a minute of it? What actions were taken by Ministers subsequent to that meeting? Were Ministers consulted about the decision to remove her from the CQC board, and did they support that decision?

Finally, the only real answer to all of these deep-rooted problems that go back a long way is for both sides of the House to recommit to full openness and transparency in the national health service. Will the Secretary of State join me today in restating that commitment and together sending the clearest and most unambiguous signal we can to the rest of the NHS?

In conclusion, there are difficult questions here for people at every level of the system. If we are to restore confidence, it is essential that they are answered and that people are held accountable for their actions. Learning from this failure and others, this House must a deliver a regulator that the public can trust, one that puts patients before its own interests. We will support the Government in that process and not stop until it is completed.

[Mr Hunt]

I welcome much of what the right hon. Gentleman says, but let me say this: he talks about getting on with implementing the Francis report, and that is exactly what has been happening. The report came to the House on 6 February. A new chief inspector of hospitals was appointed by 31 May, and the new inspections will start towards the end of this year. That will mean that many of the things talked about in the Francis report as being fundamentally important will start to be looked at independently and rigorously for the very first time.

I can confirm that there will be a duty of candour in the new Care Bill. We are looking at the extent to which it should apply to individuals, but we want to wait until Professor Berwick produces his report, because it is important to create a culture of openness, and we do not want to pass a measure that might inadvertently mean people clam up when they see a potential safety breach. We need to encourage an atmosphere where everyone talks openly about any concerns they have.

David Prior will be looking in his response to today’s independent report at whether anyone still working in the NHS, or, indeed, the CQC, may have been responsible for some of the shocking things that have been revealed. He will pass that report to me within the next two months. As I said in my statement, there will be full consideration of any sanctions or appropriate disciplinary procedures. In our response to the Francis report, we have said we want to introduce a new barring scheme to make sure that managers who have been found guilty of behaving in a bad way do not get jobs in another part of the NHS.

With respect to what the right hon. Gentleman said about my colleague, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), I gently say to him that it was not my right hon. Friend or myself or this Government’s Ministers who rejected 81 requests for a public inquiry into what happened at Mid Staffs. My right hon. Friend was the person who called the public inquiry into Mid Staffs. He is the person who changed the management of the CQC. He is the person who put clinicians in charge of budgets in the NHS, precisely to make sure these kinds of safety issues do not arise.

Finally, the right hon. Gentleman talks about accountability. If the Opposition really wanted to give confidence that they take the issues raised today seriously, they would recognise that it was fundamentally wrong to set up an inspection regime that was not carried out by specialists, and where the same person was inspecting a dental clinic, a slimming clinic, a hospital or a GP practice, perhaps in the same month. That may have contributed to the CQC’s decision in 2009 not to investigate the maternity deaths at Morecambe Bay, and to its decision in April 2010 to register the hospital without conditions.

When it comes to accountability, the right hon. Gentleman needs to explain to the House why the former head of the CQC, Barbara Young, said in her evidence to the Francis inquiry:

“We were under more pressure…when Andy Burnham became minister, from the politics.”

Is it the case that the head of the CQC felt under pressure not to speak out about care issues?

On the substantive policy point, the right hon. Gentleman continues to criticise the appointment of a chief inspector of hospitals and continues to criticise me when I single out hospital management who coast when it comes to raising standards. Just how much evidence will it take for the right hon. Gentleman and the Labour party to realise that when it comes to NHS policies, they really need to change?