Accountability and Transparency in the NHS

Bernard Jenkin Excerpts

Thursday 14th March 2013 Commons Chamber

[Andy Burnham]

Foundation trust status was not a matter for Ministers. It was a job for Monitor, so it has to answer that concern. The hon. Gentleman is right that we had many discussions about a public inquiry. He will remember that in July 2009, two months after I was appointed Secretary of State, I brought in Robert Francis QC to conduct an independent inquiry into what happened. I did not order a full public inquiry and I will explain the reason why later.

The difficult thing about the fact that the Mid Staffs board was holding more meetings in private was that we in this House had passed up our powers to intervene to stop it. That is another lesson we must learn: that the FT reform was naive in thinking that local autonomy would lead to improvement in all cases. In a national health service, there are areas where national direction is needed, and when things go wrong, there must be immediate powers of intervention, which, on my arrival in the Department in June 2009, I found I did not have. Foundation trust policy needs to be reviewed and adjusted to mitigate those dangers, including through a reconsideration of the power to de-authorise a failing foundation trust, which was recommended by the first Francis report, but repealed by the Health and Social Care Act 2012.

We also need to consider targets and how they are used. Targets helped to deliver the lowest waiting times in history and that must not be forgotten. However, in places, they reinforced negative management practices. In focusing on only part of the patient experience, there was not sufficient focus on the overall patient experience and the whole person—a particular problem when it comes to caring for very elderly people whose needs are a blur of the physical, mental and social.

Robert Francis is right to call for a fundamental rethink of the way in which we care for older people, and I have put his recommendations at the heart of Labour’s policy review. However, there are more immediate things that we can do and I will spend the rest of my time on five substantive points.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will make some progress.

The first point is about implementation. I would like to take this opportunity to thank Robert Francis for his work on this inquiry and the previous inquiry, which I commissioned. Robert Francis has taken the best part of three years to consider these matters in detail and has made 290 measured and proportionate recommendations. The people affected by these events should reasonably be able to expect that they will be implemented without delay.

I make a genuine offer today to the Secretary of State. If he brings forward proposals, he will have our support in speeding up implementation. I say that because I am becoming concerned about the timetable for the Government’s response. On 6 February, the Prime Minister told this House:

“We will study every one of the 290 recommendations in today’s report and we will respond in detail next month”.—[Official Report, 6 February 2013; Vol. 558, c. 281.]

Since then, the Government have commissioned a review of the recommendations, which is due to report in July. Although, like the hon. Member for Bristol North West (Charlotte Leslie), I have great respect for Don Berwick, I am surprised that the response to a long public inquiry is to set up another review. Is it still the Government’s intention to respond in detail this month? Although I welcome this debate, it is narrow in focus, so will the Secretary of State consider having a full day’s debate in Government time? Instead of more delays and reviews, we need action and a timetable for implementation. I would be grateful if the Secretary of State would respond to my offer today.

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[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.

[Mr Jenkin]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I will not.

This is a difficult time in the NHS. The chief executive of the NHS has described it as a period of “maximum risk” as it struggles with the simultaneous challenges of efficiency and reorganisation. Morale in the NHS is low and one thing is clear: patient care will not improve if it stays like that.

The Secretary of State is right to speak out for patients when the NHS falls short, and he should always do that. However, statements should be fair and should recognise the good that the vast majority of staff do, day in, day out, and the pressure that they are under, which is not of their own making. That balance has been missing from recent Government statements. I say to the Secretary of State that hospitals and NHS staff are not coasting—far from it. They are working flat out, with some coping better than others with the pressure that they are under.

Politicians need to do more than just point out the failings of hospitals and NHS staff. We all need to support them with proper staffing levels on the wards. We all need to support them to speak out, wherever they work. We all need to stop the reorganisations that distract them from patient care. Those are the lessons of Stafford. Today, let us all resolve to face up to them.

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[Mr Hunt]

I absolutely agree with my right hon. Friend. We will respond to the Francis report this month, as the Prime Minister has committed to do, and make plain measures to ensure that the situation cannot continue. My right hon. Friend is right to raise that point.

[Mr Jenkin]

rose—

[Mr Hunt]

I will make some progress and then I will take more interventions.

My response will detail how we intend to restore accountability to the boards of hospitals, and today I have removed the ability of any hospital to insert gagging clauses on patient safety in compromise agreements made with senior staff. My hon. Friend the Member for Bristol North West asked whether that will be retrospective, and I have written to all trusts to remind them of their responsibilities towards whistleblowers in respect of contracts and compromise agreements already signed. If we are to protect patients, we need an atmosphere of openness and transparency in the NHS—something to which the motion rightly refers.

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[Mr Dorrell]

The position I take is the one set out in the Francis report, which was explicitly endorsed by Sir David Nicholson in the Select Committee inquiry to which the hon. Lady has referred. I believe that it would also be endorsed by my right hon. Friend the Secretary of State, but he must speak for himself. That position is that it is hard to imagine circumstances in which the use of public money in the context of a compromise agreement should be governed by a confidentiality clause. In an age when a bill from Pizza Express has to be published on the internet, decision makers should be held publicly accountable for the use of large sums of money in the context of a compromise agreement.

[Mr Jenkin]

I accept my right hon. Friend’s challenge about openness and transparency in the way the health service reacts outwardly, but that is a means to an end. There is also a lack of honesty and openness between people working in the health service, and the mistrust between levels of management and institutions inhibits the proper flow of information and the ability of people to trust each other in the context of saying what is wrong and putting it right. People in the health service dare not tell their senior management what is wrong.

[Mr Dorrell]

I have a lot of sympathy with what my hon. Friend says. The successful delivery of a culture change that supports real transparency would build on the fact that it is not only a right but an obligation for a registered doctor or nurse who sees care being provided that falls below proper standards to raise their concerns and, if no action is taken, for those concerns to be raised with the regulator. Change will be required right through the health service if that professional obligation is to be made real.

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[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am encouraged by the speech from my hon. Friend the Member for South West Bedfordshire (Andrew Selous) because it shows that accountability is not just about supervising organisations, regulators, targets, safeguards, mechanical things and statistics. Accountability is about creatively getting the intelligence into the system about what is happening and reacting to it positively, welcoming it and generating the complaints so that more intelligence comes into the system. That is the kind of accountability we want.

As Chairman of the Public Administration Committee, I feel I can add a new dimension to the debate because of what we are thinking about in our inquiry on the future of the civil service. We need to ask ourselves, “What does accountability feel like?” We think we know what accountability feels like, but my goodness, it goes up and down a bit. During the previous Parliament we felt very accountable in some periods, every single one of us. What do we want accountability to feel like in the health service? With the greatest respect to my hon. Friend the Member for Wycombe (Steve Baker), the lawyers must be the last resort. We do not want accountability to be about finger-pointing, blame and holding people to account. Indeed, that is part of the disease that afflicts the health service. We want accountability to be about nursing staff on the ward feeling accountable to each other for sharing information, accountable to the patients and welcoming the information they receive from them, and accountable to their managers and holding them accountable for what they do not feel is being done, in an atmosphere of trust and co-operation.

What is chilling about the Mid Staffordshire story is the question of what accountability felt like in that hospital at that time? To whom did people feel they were accountable. What did they feel they were accountable for? There must have been almost an atmosphere of “Apocalypse Now” in the hospital, in which nobody knew where to turn.

In the evidence we are receiving about the civil service, we have had powerful testimony from an adviser to our Committee, Professor Andrew Kakabadse of Cranfield university, who rather chillingly points out an obvious truth. Very few people who work in a failing organisation do not know that it is failing. Most people in a failing organisation know that it is failing. What is wrong? The answer is that they do not know how to talk about it. They do not know what to say, who to tell—or, if they try to tell people, it will be bad for them—or what to do. So people often just leave failing organisations, saying, “I can’t do anything about it.” I bet most of those on the board of the hospital trust knew it was going wrong and did not know what to do. There is this idea that this was just an isolated case, but it represents a systemic failure. There is absolutely no escaping that.

I remember the Paddington rail crash. One’s instant reaction was, “Well, the driver went through a red light; it must have been his fault,” but everybody knew that there must have been something much more fundamentally wrong. Something was wrong with rail safety. In aviation, when there is a plane crash, it is very rarely the pilot’s fault. Even if it is down to pilot error, that will be down to pilot training and that will be a system failure. We need to look at this issue in an holistic and sensible way.

The reaction of the NHS to the Francis report was immediately to reach for statistics and to start doing things. It immediately started a storm around our local hospital, the Colchester General, by latching on to one statistic and naming it as one of the hospitals being investigated, even though—I have written to Andrew Dilnot at the UK Statistics Authority and got a reply from him—a single statistic should never be used in such a fashion. In fact, the Colchester General is in the top quartile of its class of hospital, so that was entirely unnecessary. My wife has just had a knee replacement in that hospital. I was completely confident that she would get good nursing care and she indeed got very good nursing care.

There is now an uncomfortable atmosphere surrounding this issue. There is an atmosphere of denial, and this relates to Sir David Nicholson. Is he still in denial? Is the system still in denial? Can the system change dramatically enough unless people are seen to take responsibility for the culture? It is difficult to argue that he has not been individually responsible for the broad culture in the national health service that has led to this pass.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am sure the House wishes Anne Jenkin a speedy recovery.