Hospital Mortality Rates

Andy Burnham Excerpts

Tuesday 16th July 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

First, let me join the Secretary of State in thanking Sir Bruce Keogh and his team for this important review. Having worked closely with Sir Bruce, I know him well and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, we accept the findings of this report in full.

The statement we have just heard, however—the partisan statement—was not worthy of the excellent report that Sir Bruce has delivered today. The Health Secretary claimed at Health questions that this was a historical report, all about the past and the last Government. Well, I have got news for him: it is not. Trusts were identified on the basis of mortality data for 2011 and 2012. This report is about the right hon. Gentleman’s Government and failings that are happening now on this Government’s watch.

Anyone who supports the NHS must always be prepared to shine a spotlight on its failings, so it can face up to them and improve. In so doing, we must be fair to staff and the NHS as a whole. I am pleased to say that Sir Bruce is fair in his report. He says early in the report that the failings of the 14 hospitals must be put in context, stating that mortality in “all NHS hospitals” has been falling over the last decade by about 30%. He rightly reminds us of

“decades of neglect in the NHS in the 1980s and 1990s”,

and he speaks of the challenge facing the last Government in their early days. The key issue, he said,

“was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

The last Labour Government dealt with that issue; I am proud of it and we are proud of our record on the NHS.

The balanced picture presented in this report is not recognisable from the Government briefing appearing in the weekend newspapers. In fact, this report exposes one of the more cynical spin operations of recent times. Nowhere in this report does the claim of 13,000 avoidable deaths appear. Sir Bruce is clear, so let me quote him directly:

“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”,

but that is precisely what this Government chose to do in advance of this report. They made unfounded claims, which will have alarmed people in the areas served by the 14 hospitals, and they have questioned the integrity of the staff working in those hospitals in difficult circumstances—and all for their own self-serving political ends. That is simply unworthy of any responsible Government. On reading this review, the diversionary spin operation now makes sense because it reveals evidence of deterioration at all 14 hospitals on their watch.

Let me turn to one of Sir Bruce’s central findings—unsafe staffing. One of the report’s major concerns is that trusts have allowed staffing levels to drop to dangerously low levels. It says:

“When the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas.”

Already, the review team has had to intervene on staffing levels in three trusts to protect patient safety.

The Secretary of State claimed in his comments that the Care Quality Commission had failed to spot any problems. Working with the CQC during the last Government, I left in place warnings about five of these hospitals. The Secretary of State claims that we were covering up, so let me answer on the question of Ministers’ integrity and cite the Francis report, which said that there was no evidence that any Minister received or ignored advice that would have led to safe outcomes. Let me quote to him from a letter sent by Baroness Young to the Prime Minister yesterday:

“CQC was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures.”

It is outrageous for the Secretary of State to come to the House today and repeat those concerns without a shred of evidence to back them up.

Five of the trusts examined by Keogh had warnings in place, and it is shocking that they have been allowed to cut staff to unsafe levels on this Government’s watch. Overall, seven of the trusts in the review have cut front-line staff by a shocking 1,117. The great sadness is that it appears Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified “dangerous cuts” to the front line as a primary cause of care failures. Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Is it not the case that the Secretary of State can no longer ignore these authoritative calls, and will he take urgent action on safe staffing levels in these 14 trusts and across the NHS? Will he accept that the loss of over 4,000 nursing jobs that has now been laid bare under this Government is a monumental mistake, while £3 billion has been siphoned out of the NHS front line to pay for reorganisation that nobody wanted and nobody voted for?

Let me turn to A and E performance, the barometer of the health service and a wider indication of problems across hospitals. The report highlights major failings in A and E at many of the trusts and we know that the NHS has just come through the worst winter for a decade. At the end of last year, all 14 trusts were in breach of the Government’s A and E target—when, under the previous Government, all 14 were meeting the A and E target.

Sir Bruce is clear that urgent action is needed to improve A and E. Let me quote the report:

“We have established that one of the primary causes of high mortality in these hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients…All trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellation of operations due to bed shortages and difficulty meeting waiting time targets.”

Will the Secretary of State now take immediate action, working with the whole health economy in these 14 areas, to bring each trust back up to the national standards on A and E that his Government have set? Will he accept that it is not fair to these hospitals to blame them alone, as the devastating cuts to social care are a major driver of pressure in hospitals?

Finally, on what happens next, the simple truth is that people watching will want solutions rather than point scoring. Surely the right response to the Keogh review is now to accept the Francis recommendations in full, particularly on minimum staffing. A duty of candour on individuals will help bring the culture change we need at local level and, of course, we need to see the regulation of health care assistants. Will the Secretary of State work with us now on early implementation of the Francis recommendations? He spoke earlier of a new era of transparency. If he means what he says, will he now publish the NHS risk register? For all we know, it might well have predicted some of the failings we are reading about today.

It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What matters is how the NHS responds. Rather than pulling down the shutters and pushing people away, it is right that we should hold a mirror up to the NHS so that it can act on its failings. We must also be fair to people working in the NHS by ensuring that an accurate picture is presented. Sir Bruce has had to take the extraordinary step already of distancing himself from the Government briefings that appeared at the weekend. I hope the Government will learn a painful lesson from this: you should not play politics with people’s lives and you should not play politics with the NHS, on which all people depend.

[Mr Hunt]

Mr Speaker, it is hard for a serving Health Secretary to admit that things can go wrong in the NHS, but we know today that it is even harder for a former Health Secretary. We have heard nothing but shameful denial. The right hon. Gentleman—[Interruption.]