Mid Staffordshire NHS Foundation Trust

Andy Burnham Excerpts

Tuesday 26th March 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for the measured way in which he introduced it.

The NHS is 65 this year, and if it is to be ready for the challenges of this century, it must learn from the darkest hours of its past. The NHS was founded on compassion and, as the Secretary of State said, what happened at Stafford was a betrayal of that. Rightly, apologies have been given, but it is now time to act and make this a moment of change.

Robert Francis delivered 290 careful recommendations after a three-year public inquiry and, like the Secretary of State, I pay tribute to him today. In response, the Prime Minister promised a detailed response to each recommendation by the end of this month. Although the Opposition welcome much of what the Secretary of State has said today, his statement falls short of that promised full response and contains serious omissions on which I would like to press him, in particular, on four of Robert Francis’s flagship recommendations, which I shall take in turn.

First, we welcome the move to place a duty of candour on health care providers and believe it could help bring about the culture change the NHS needs. The Francis report, however, goes further and recommends a duty of candour on individual members of staff. Will the Secretary of State say more about why he has only accepted this recommendation in part and not applied it to staff? Has he ruled that out or is he prepared to give it further consideration?

Will the Secretary of State assure the House that the duty will apply equally to all providers of NHS services, including private providers? His statement was a little vague on that point. More generally, with more private providers coming into the NHS, is it not the case that we will not get the transparency we need unless the provisions of freedom of information apply fully to all holders of NHS contracts and information cannot be withheld under commercial confidentiality?

Secondly, on patient voice, the Government have announced new chief inspectors of hospitals and social care. Those were not Francis recommendations and, while we give them a cautious welcome, I am sure that the Secretary of State will agree that regulation alone will not be enough to prevent another Mid Staffs. Instead, we need a powerful patient voice in every community that is able to sound the alarm if things are going wrong. Rather than pulling down the shutters, as the NHS has a tendency to do, complaints should be embraced as opportunities to learn and improve.

It is just a matter of days until the new NHS comes into being and the concern is that patient voice has not been embedded at the heart of the new system. A third of councils say that their local healthwatch will not be up and running by the 1 April deadline, and there are wide variations in both structure and membership. Will the Government accept Robert Francis’s recommendation of a consistent basic structure for healthwatch programmes throughout the country before it is too late and they go their separate ways?

Thirdly, on regulation and training, Robert Francis has made a very clear case for a new system of regulation of health care assistants to improve basic standards—a case that we made during the passage of the Health and Social Care Act 2012—yet it did not feature in the Secretary of State’s statement. Have the Government accepted in principle the regulation of health care assistants?

We support moves to rebalance nurse training and to include more hands-on experience, but student nurses already spend 50% of their time in clinical practice and face significant financial barriers when completing their training. Will the Secretary of State assure the House that requiring a year on the ward will not increase the financial barriers to young people entering nursing and, if more trainees are to be on the wards, will he ensure that there are enough staff with the time to train the extra students?

That takes me to my fourth point and the most glaring omission from the Secretary of State’s statement, namely safe staffing levels. We will never get the right culture on our wards if they are understaffed and over-stretched, but there is evidence that things are going in the wrong direction and the Secretary of State was silent on the issue today.

The CQC has recently reported that one in 10 hospitals in England do not have adequate staffing levels. Just last week, work force figures showed that there had been a reduction of 843 nurses between November and December last year. Does that not sound the clearest of alarm bells that some parts of the NHS are already in danger of forgetting the lessons of its recent past by cutting the front line too far? Do not communities need a clear, objective benchmark so that they can challenge staffing levels on wards, and would it not be a great help to them for the Francis recommendation on staff-patient ratios to be accepted? We learned last week that the Department has handed £2.2 billion from last year’s budget back to the Treasury. Surely that money would have been better invested in the front line and in bringing all hospitals in England back up to safe staffing levels.

Finally, I want to turn to Stafford hospital itself, which Monitor has recommended should be placed in administration. This doubt about the hospital’s future will be causing real concern to the people of Stafford. After all they have been through, I think we can all agree that they deserve a safe and sustainable hospital, and I hope the Secretary of State will soon set out a plan to achieve that.

Learning the lessons of Stafford cannot be done overnight. We all have to play our part. The Government have made a start today, but much more needs to be done and we will hold them to that.

[Mr Hunt]

The right hon. Gentleman talks about glaring omissions in the Government’s response, but there were glaring omissions in his response too. Where was the apology for Labour’s targets culture that led to so many of the problems; the apology for failing to set up a regulatory structure that had proper safeguards; and the apology for missing all those warning signs? This was not just the darkest day in NHS history, but the darkest day in Labour’s management of the NHS. It is time the Labour party recognised the policy mistakes it made.

Let me go through what the right hon. Gentleman says are omissions. First, on the duty of candour, we accept the principle of the duty of candour when it applies to hospital boards, but we want to be absolutely sure that there are not unintended consequences of applying it to hospital staff, because another part of the Francis report is on the importance of a culture of openness and transparency, and we do not want a culture of fear. We have therefore not ruled out criminal sanctions for hospital employees who breach a duty of candour—they already have a contractual duty of candour —but, as I said in my statement, we want to wait for the result of Don Berwick’s report on zero harm to ensure that we do not take any measure that impedes the openness we need in hospitals.

The inspection regime will apply to all providers. It is important that it should, but I remind the right hon. Gentleman, who mentioned private providers, that the problems happened at an NHS hospital. Trying to turn this into a debate on privatisation tells people that Labour is missing the point in the response to Francis.

We will not introduce statutory regulation of health care assistants, but we will introduce minimum standards of training for them. We will not introduce statutory regulation because we believe there is a risk that a database of 0.5 million to 1.5 million people could end up being a box-ticking exercise that fails to raise standards in the way we need. We believe we have another way to achieve the same end, which is what we will implement.

On nurse training, we believe it is important that nurses have hands-on experience of the front line, because nurses, when they are properly qualified, will be managing health care assistants. It is therefore important that nurses understand what it is like to be a health care assistant. We will be very careful in how we implement that to ensure that we do not create financial barriers because, obviously, we want to attract the best people into nursing, regardless of income.

On staffing levels and nursing numbers, I remind the right hon. Gentleman that the problems at Mid Staffs happened when Labour was in power, when budgets were going up quite significantly, and when numbers were going up. To distil the problem to one of numbers is, again, to miss the point. This is about the values of the people on the ward. If he wants to talk about numbers, he must accept that, because this Government have protected the NHS budget, which he wants to cut from its current levels, there are 6,000 more clinical staff in the NHS today than there were at the time of the last election.

On Stafford hospital, it is extremely important that, when we have problems such as the ones at Mid Staffs, we create a structure that makes it impossible not to deal with them. That is a difficult process. We are announcing today a time-limited process to ensure that Ministers and the system cannot duck difficult decisions when we have a failing hospital. Obviously, we will follow the Monitor trust special administrators’ recommendations and look at them carefully, but it is important to address the issues. The wrong thing to do would be to fail to do so, because that would lead to clinical failure.

I welcome the fact that the right hon. Gentleman broadly accepts the Francis recommendations. He asked whether we would respond to all of them. The inquiry was a public inquiry, which he refused to set up. As a result of that detailed public inquiry, there are 290 recommendations. It takes time to go through all of them in detail, but I thought it was right to come to the House today with our initial response so that we can get cracking with the important things right away.