NHS (Five Year Forward View)

Bernard Jenkin Excerpts

Monday 1st December 2014 Commons Chamber

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

I welcome every word of my right hon. Friend’s statement, not least because his fourth pillar on culture change echoes the work done by the Public Administration Committee on complaints handling and the need for openness. His statement addresses all the needs and challenges we face in north-east Essex: the problems of openness and transparency in the local hospital and the need to transfer more of what the hospital does back to the community providers—to the multidisciplinary providers that need to be in the community. I welcome the £1 billion fund for developing community facilities, but how is he going to persuade the CCGs to transfer some of their commissioning power to these units? A hospital in Harwich, which was built under the last Labour Government, has two operating theatres that have never been used because the CCG, and its predecessor the primary care trust, would not commission services through those facilities.

[Mr Hunt]

I thank my hon. Friend for his long-standing support for the importance of transparency in driving up standards in health care. He has championed that for his own hospital, which has had particular issues on that front, but also through his role in this House, and he is absolutely right to do so. On his substantive point, we will get CCGs to do what he suggests through the reforms that I have announced, which will encourage them to take a holistic view of the health care received by the patients for whom they are responsible. In particular, we have got to move away from commissioning care piecemeal—commissioning a certain number of hips or a certain number of mental health consultations—and start looking at patients and all their needs in the round. If we commission in that way, we can avoid a number of the human tragedies that have come to light.

Patient Safety

Bernard Jenkin Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

First, I will ensure that throughout the system when we have failures in care we are completely transparent about them and do not seek to brush them under the carpet. That is a very important change. Secondly, yes there is pressure on ambulance services, just as there is pressure in most parts of the NHS now, but under this Government our ambulance service is taking 1,000 more people every day on emergency journeys. We should credit it with doing a very good job in difficult circumstances.

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

I commend my right hon. Friend for being determined to create a different and more effective safety culture in the NHS, just as in the airline or oil and gas industries. Does he accept that publishing more data is only part of the equation and will not necessarily change attitudes and behaviours, particularly if those data are then gamed at another target? We must tackle attitudes and behaviours at source—in the operating theatre, the GP’s surgery and throughout the whole service—to get that better safety culture.

[Mr Hunt]

As ever, my hon. Friend speaks wisely. The first step is to be open and transparent about where the problems are, and I hope today will be a step in that direction. In the end, however, if we are to change things we must create a learning culture in all our hospitals so that the word goes out from the top down that the management is interested in hearing from staff if they have concerns about safety, because it wants to learn from those concerns and put them right. One of the messages I have been trying to get across is that that does not cost money; it saves money. We spend £1.3 billion a year on litigation and £800 million on adverse events. If we are feeling, as everyone is, a tough climate financially, this is a positive thing to do for that reason as well.

Francis Report

Bernard Jenkin Excerpts

Wednesday 5th March 2014 Commons Chamber

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

I believe that the Francis report is becoming a major turning point in the life of our national health service, which is one of our great institutions and is probably treasured above every other institution that the British people hold dear. The Francis report has moved the NHS from being a rather impenetrable bureaucracy into something that is much more fallible, human and compassionate.

The Francis report highlighted the failings at Mid Staffordshire NHS Foundation Trust and stated that they were very much the result of a failure of leadership. As Francis said:

“The patient voice was not heard or listened to, either by the Trust Board or local organisations which were meant to represent their interests. Complaints were made but often nothing effective was done about them.”

Damningly, he found:

“There is no evidence that the substance of any complaint was ever raised with the Board.”

I shall come back to that point later. He also said:

“Such an approach completely ignored the value of complaints in informing the Board of what was going wrong, and what, if anything, was being done to put it right.”

As Members have been saying, this reflected a culture of denial about failings and complaints not just at Mid Staffs, but across much of the NHS. We know that the problems were wider than this one trust. In a report last year the parliamentary and health service ombudsman, whose office is the responsibility of the Committee that I chair, the Public Administration Select Committee, carried out a survey of 94 trusts from across England and found that only 20% of boards were reviewing learning from complaints and taking resulting action to improve services; less than half were measuring patient satisfaction with the way complaints were handled; and less than two thirds were using a consistent approach to reviewing complaints data. One other finding, from memory, was that only 2% of trusts were considering complaint handling as a strategic issue to consider during a trust board awayday.

[Jeremy Lefroy]

Will my hon. Friend share his reaction to the news that the parliamentary and health service ombudsman is taking far more seriously complaints brought to her and instigating far more investigations than two or three years ago?

[Mr Jenkin]

Yes, I welcome that. My Committee works closely with the PHSO, Dame Julie Mellor. I paid a visit to the PHSO’s office in London last week and listened to some of the complaints coming in by telephone. We have a lot to learn from the way she is changing things, but there is a lot we need to do to bring the institution of the ombudsman into the 21st century. My Committee is working on a report to be published shortly, which will make recommendations on that.

The role of boards in the leadership of NHS trusts has not been given sufficient attention. Many boards are changing their practices and improving, but the research that we have been given suggests that the chairman of the board of a trust is the most important person in setting the tone of the organisation. We inherited a system where executives took all the decisions and the role of boards was to oversee. No. In the private sector, the chairman of a company, even the non-executive chairman of a company, is the most crucial person for setting the tone, the values and the atmosphere in the organisation. We need to lay much more emphasis on the leadership of trust boards.

The Francis report prompted the NHS, Government and Parliament to question the prevalent management culture in the NHS, and it is the main reason why we are looking not just at the ombudsman, but doing an inquiry into how complaints are handled not just by the NHS, but by Government Departments and across public services. As part of our inquiry we took evidence from Sir David Nicholson, the chief executive of NHS England, and Chris Bostock, head of NHS complaints at the Department of Health.

The ombudsman told us that she found what she called a “toxic cocktail” within some NHS hospitals which combines a reluctance by patients, carers and families to complain, with a defensiveness on the part of hospitals and senior staff to hear and address those concerns. In oral evidence to our inquiry, Sir David accepted that when he said:

“I do think there is a real issue about defensiveness and a lack of transparency in the way that we work”,

and he accepted that complaints are important for learning and improving.

A great deal has been said in this debate about processes, procedures, legal sanctions, rules and accountability, but those are for when things go wrong. What we want in our health service is a culture of listening, understanding, caring, learning and supporting. I shall say a little more about that. Sir David said that the need for openness is not always recognised in the NHS. He went on to say that

“we are publishing lots of data and information and people can connect together through social media and all the rest of it, things are opening out, but the leadership of the NHS…is having difficulty coming to terms with that and”—

a rather nice little understatement—

“is slightly behind it.”

He accepted that that came down to leadership and culture. In a powerful admission from somebody who has been at the heart of the NHS for so long, he said:

“Undoubtedly, in broad terms, the NHS leadership is not equipped to handle some of the big issues that are coming forward, so we need to tackle that leadership. We need to work really hard on the culture of the system overall, because as you are going through that transition the importance of setting the right tone from top to bottom of the organisation is increasingly important…You need to make sure that you are learning the lessons and getting innovation from the system as a whole.”

I am bound to add that, at the end of the session, I asked him about his own leadership. It is a credit to him that he explained that the diagnostic process that NHS leaders go through had been applied to him. He said:

“What it said about me was that first of all I was strong on the pace-setting. Give me a target and I will make it happen…Secondly, the feedback was that I was good at setting out a vision of what the future might look like. My weaknesses were around facilitating and coaching, and actually they are the issues that in a modern NHS will be much more highly prized than perhaps the last one.”

I know that Sir David Nicholson has come in for an awful lot of stick and criticism, but there was a degree of self-knowledge there, and he expressed much regret in front of our Committee for what he had missed.

Francis recommended changes to the law, and the Government are implementing those recommendations. However, I agree with the Select Committee on Health that enshrining duties and standards of care in statute is simply not enough. In fact, statutory changes are almost irrelevant to the day-to-day life of people working in the NHS. The word we hear often is “culture”, and that is what needs to change and is changing. The key change needs to be to attitudes and behaviour within the NHS, particularly among those in leadership positions, who set the tone of the organisation that they lead. Leadership is central to that—not just the leadership of trusts, but leadership across the organisation at all levels.

The Secretary of State is right to emphasise the importance of compassion in the NHS and the need to support those who are required to show compassion every day. Management need to feel and respect that compassion and reflect it in how they treat their staff, otherwise, as one colleague said to me, patients become objects, not people. The way health care staff feel about their work has a direct impact on the quality of patient care as well as on an organisation’s efficiency and financial performance. If those in the upper tiers of management are not also involved in feeling compassion for the patient, they place too great a burden of compassion on front-line staff. The people on the front line need support from those up the management chain, and compassion has to come from the top.

High-quality, patient-centred care depends on managing staff well, involving them in decisions, listening to what they have to say, developing them and paying attention to the physical and emotional consequences of caring for patients. Funnily enough, that point was made by a commercial witness to the Public Administration Committee’s inquiry into complaint handling, Mark Mullen, the chief executive of First Direct. He told us that

“there is a relationship between how you treat your people and how you ask or expect or want your people to treat their customers…it is virtually impossible to create a positive outcome with customers unless you have created a positive relationship with your own employees.”

I wish to leave the House with that serious thought—how NHS staff feel about their work has a direct impact on the quality of patient care, as well as on efficiency and financial performance. That is what this is about.

I am taking a close interest in the NHS leadership academy, which the Secretary of State referred to. It clearly has a clear role to play, although it is very small at the moment. It deals only with potential trust chief executives—senior leadership in challenging roles. It is early days, and we need to involve the academy with trust boards, trust chairs, the leadership of NHS England and even the Department of Health. The academy must give priority to the values of compassion, openness and transparency, listening to and learning from complaints and accepting and learning from failure. It is not about people going off to Harvard, learning how to develop fantastic strategies and coming back with a personal vision that they impose on their organisation. That is not the kind of leadership the NHS needs, and indeed, such leadership does not work in business either. That is true not just for a few leaders, but for every leader of every team in every trust and GP practice in NHS England and the Department of Health. It is a much bigger agenda for the NHS leadership academy than currently envisaged, but we need that ambition if there is to be speedy and permanent change in the culture of the NHS, the attitudes of the people in it, and the way they behave.

There is a great deal of excellent practice in the NHS, as in most large organisations, but it does not seem to be gathered in any systematic way so that learning can be shared. One consequence of that is that there does not seem to be a shared understanding of the kind of leadership that makes excellent practice more likely. Despite the scale and complexity of the health service, there is a common commitment to compassionate, safe, sustainable care among clinicians, managers, trusts, chairs and regulators, which could be the foundation for building a shared understanding of good leadership and practice. None of this will be a quick fix, but many building blocks of good practice are already in place. Gathering that learning together would strengthen and hearten leadership across the NHS. I believe that that is the real role of the NHS leadership academy as it builds its capacity, and I look forward to its developing in the future.

--- Later in debate ---

[Dr Poulter]

I will talk about complaints a little later, but the right hon. Gentleman has made some important points. When we consider how to improve the delivery of care in our health service, it is important that we examine international comparisons. The system in New Zealand includes a different form of compensation, and perhaps that is partly why it has a more open culture—there could be many other factors. It is acknowledged much earlier in the process that something has gone wrong, and there is a genuine attempt to explain the situation to the family and say sorry. That is what good health care is all about.

No matter how good, well trained and dedicated staff are, things will sometimes go wrong in a health service. When they do, it is important that we are open and honest with patients and that we do our best to put things right if we can, or explain and apologise if we cannot. That is why we believe that the duty of candour needs to exist at organisational level. Of course, I am happy to write to the right hon. Gentleman, or meet him if he would like to talk through some of the issues that he raised today. He makes good points, and I know that he does so on a completely apolitical basis because he has the best interests of the health service at heart. We might disagree on other issues, but on this one it is worth having a meeting to discuss his views further.

Subject to the passage of the Care Bill, a new criminal offence will be introduced to penalise providers who give false or misleading information where that information is required to comply with statutory or other legal obligations. It means that those directors or other senior individuals, including managers, who consent to, connive in, or are negligent regarding an offence committed by the provider could be subject on conviction to unlimited fines or even custodial sentences. We must ensure that managers and those running the health and care service in a health care provider provide information in an honest and transparent way that is always in the best interests of patients.

Importantly, we are introducing through the Care Bill a single failure regime to ensure that failure is not only about the financial sustainability of the trust, but about whether a health care provider is providing good care, and the quality of that care. One problem in the past with the trust special administration regime has been that it is rarely used. When it is used, however, it is important to ensure that it is there to protect patients. Often in the past it was used only in a way that focused on financial failure. One important lesson to learn from Mid Staffs is that there should be a failure regime that also considers quality of care. Hospitals are not just about good accounts; they are primarily about delivering good care, which is why we need a single failure regime. My right hon. Friend the Secretary of State has been a tremendous advocate for the importance of quality of care in trust, and he should be commended for that. Thanks to him, we are now ensuring that we improve the TSA regime in that way.

[Mr Jenkin]

The Minister is outlining the legislative and regulatory changes that arise from the Francis report, but does he agree with the Health Committee, which attaches far more importance to the leadership academy mentioned by my right hon. Friend the Secretary of State? Is not the quality of leadership much more important to the day-to-day care that is delivered throughout the health service, and will the Minister say a bit more about that?

[Dr Poulter]

I am not sure whether my hon. Friend has seen my brief, but that was exactly the point I was coming to. He is absolutely right and he highlighted the issue earlier in a strong contribution to the debate. It is important to empower front-line staff to be advocates for patient care and to take leadership roles in hospitals. Clinical leadership is at the core of everything that needs to be done, and we must promote strong leadership throughout a health care organisation, and throughout the sector.

We amended the Enterprise and Regulatory Reform Act 2013 so that a person has the right to expect their employer to take reasonable steps to prevent them from suffering detriment from a co-worker as a result of blowing the whistle. That has supported clinical workers and front-line staff in raising concerns and as whistleblowers. We established the NHS Leadership Academy in 2012 as the national hub for leadership development and talent management. Since it launched its NHS fast-track executive programme in January, there have been more than 1,600 applicants. We are also introducing a new fit and proper person test for directors of registered health care providers, which will allow the CQC to insist on the removal of directors who are responsible for poor care. Those strong steps are in place, and there are others, which I would be happy to discuss another time with my hon. Friend, to embed not just clinical leadership but good leadership throughout our health and care services.

Importantly, in delivering high-quality care and embedding good leadership, we must focus much more on outcomes rather than targets. That goes to the centre of what Robert Francis said, and is led by good clinical leadership. What matters in the health service is that we deliver high-quality care based on good outcomes of care for patients, and we must listen to patients about what good care looks like. The Government are delivering those things, which are at the centre of what Robert Francis recommended as lessons to be learned from Mid Staffs.

Finally, I mention the important issue of embedding the patient voice and listening when things go wrong. As the shadow Minister outlined, the Government have introduced the friends and family test, through which nearly 1.6 million patients have already given instant, real-time, feedback to the NHS about their care. Patients are saying what their experience of care is like. It is not about ticking a box or meeting a target; patients are feeding back information and saying, “Yes my care was good” or “No, my care was not as good as it could have been, and this is how it could be improved.” Good care is about ensuring that we deliver clinical excellence through clinical leadership, listening to patients, and ensuring that we feed back their experiences into delivering better services and a better experience of care. Those are things the Government are doing.

Through the chief inspectors of hospitals, social care and general practice, we are putting proper clinical leadership into the inspection process. We are also ensuring that all feedback from patients, whether concerns voiced on the ward or complaints made once they are back at home, makes a difference. I pay tribute in particular to the work done by the right hon. Member for Cynon Valley on the complaints process, on which there were valuable lessons to be learnt. I thank her for her efforts, which have made a big difference. We are still working on further measures we can put in place to ensure that complaints are listened to. This is all about listening to patients, learning lessons and delivering better care.

We are proud of our record in government in listening to patients and ensuring that we develop proper clinical leadership. We are also proud that, as a result of the Francis report and the measures put in place by my right hon. Friend the Secretary of State, we are beginning to deliver much greater transparency in our health service. It is also important that we have that transparency in the back office. I disagree with what the shadow Minister said about not needing to reorganise the back room. We have to deliver more transparency, better procurement and improvements in how we run the hospital estate. If we do that properly, there will be more money to deliver high-quality patient care.

The coalition Government—I know the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), agrees with me strongly on this—want to see a more productive NHS that is patient-centred and does not waste money in the back office that should be spent on patient care. I make no apologies for organisational steps such as the removal of many of the bureaucratic processes in place under the previous Government, thus saving £1.5 billion a year already. That is good, because it means that more money goes to the front line to deliver high-quality patient care.

The 65th year of the NHS was perhaps its most challenging—certainly in recent memory. The Francis inquiry threw up many challenges for our health and care system, but I believe we are meeting those challenges. Our Government are ensuring that our NHS remains a health service of which we can all be proud, not just today but for many years to come.

Question put and agreed to.

Resolved,

That this House has considered the matter of the Francis Report: One year on.

Mid Staffordshire NHS Foundation Trust

Bernard Jenkin Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

I have concerns about how much that service is used. My particular concern is not so much whether employers are checking before they employ someone, but whether they are informing the service that an employee should be referred to it for delivering inappropriate care. That is something that we will look at.

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

I remind my right hon. Friend that the Public Administration Committee is conducting an inquiry into complaint-handling across the public service and that Essex recently had an instance of failure at our local hospital, where complaints were not properly handled. How does my right hon. Friend intend to deliver on his statement that “all patients will be able to access independent help in making their complaint”? May I suggest to him that, rather than setting up a new structure or body, perhaps the ombudsman is the right body to help facilitate those complaints, because it would create a one-stop shop for them?

[Mr Hunt]

We have avoided setting up a new structure or body in our response to the recommendations made by the right hon. Member for Cynon Valley. As for how we will make sure that this happens, I agree with my hon. Friend that the ombudsman is the final port of call if someone is not satisfied with the way in which their complaint has been treated. That is incredibly important, and the ombudsman has herself agreed that she will handle vastly more complaints and go into detail a lot more than she does at present, which is welcome. Prior to that stage, however, lots of people feel that complaining directly to the trust, which has to be the first step, is a very daunting and difficult process and that they want independent help. That is why we have said that it will be an absolute requirement for trusts to show people how they can access that independent help and, indeed, to be prepared to make the finance available so that they get that help. There will also have to be signs on every ward telling people exactly how to do that.

Hospital Mortality Rates

Bernard Jenkin Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

According to Professor Jarman on the radio this morning, the answer is that it has been falling slightly.

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

I welcome the fact that Colchester general hospital is not being put in special measures. That expresses Monitor’s confidence in the current leadership of the hospital, which is already implementing improvements in the areas that it told the Keogh report about, which are reported to be the matters of concern. I also welcome my right hon. Friend’s emphasis on leadership, and openness and trust of leadership, but does he accept what we are finding in the Public Administration Committee’s inquiry into complaints handling in public services that that lack of trust and openness is found not just at trust level, but goes right up the command chain of the health service and has historically existed in the Department of Health? How will he challenge that culture and define the right kind of leadership that should be taught by the leadership academy?

[Mr Hunt]

My hon. Friend makes a very important point. The simple way we can change that culture, which will not be easy and will not happen immediately, is by making sure that where there is failure, there is someone who is independent and able to speak up about that failure without fear or favour—someone to be the nation’s whistleblower-in-chief. That is what we must have with the new chief inspector of hospitals, modelled on the chief inspector of schools and how well the whole Ofsted regulation system has worked. That has to be the first step; there must be no hiding place when there is failure. From there, we will have the pressure on the whole system, right the way up to Ministers, to make sure that failure is sorted out.

A and E Departments

Bernard Jenkin Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

That target led to many problems, as the hon. Lady well knows. She might remember, from the 2005 general election campaign, the issues of people being denied appointments for three, four or five days because GP surgeries were being paid to meet specific 48-hour appointments. That is one issue. Too often, if people call GPs for an appointment, they are told that the earliest they can have one is in two, three or four weeks, which makes them think, “What are my alternatives?” and leads them into A and E. We must think about how we can change that and alter the incentives in GP contracts so that they can give the kind of service to their lists they would like to.

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

Do I need to remind my right hon. Friend that the outgoing Labour Government in 2010 left a note on the desk of the Chief Secretary to the Treasury saying, “There’s no money left”? Is not the challenge the need to make the NHS work on more or less flat funding—though we are doing our best to increase it—while dealing with huge increases in demand? Is not the only answer to do more in the general practice setting, where it can be done more responsibly, more local to patients’ needs and more cheaply, in order to take the pressure off A and E services?

[Mr Hunt]

My hon. Friend speaks extremely wisely. We must do just that, particularly for the frail elderly, people with long-term complex conditions, because they are the people for whom an A and E department can be a bewildering place, especially if it knows nothing about them and cannot access their medical records. Prevention is far better than cure, and I agree that that is one way of doing it.

Mid Staffordshire NHS Foundation Trust

Bernard Jenkin Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

I am happy to do so.

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

May I commend my right hon. Friend’s emphasis on leadership? In Colchester, we have seen periods of good and bad leadership, and good leadership is self-evidently the right answer to hospital management. Can I therefore ask him to lay more emphasis on what constitutes good leadership and trust between good leaders and their employees in the health service right through the system, including from Sir David Nicholson downwards, and not to rely overmuch on regulation, which is no substitute for good leadership?

[Mr Hunt]

I agree wholeheartedly. It is very important that we understand that the benefit of the new inspection regime will not just be that it identifies failing hospitals, but outstanding hospitals too, so that we have a good model of leadership in the system from which other managers can learn. Yes, it is really important to have the right relationships between managers and their staff, but we should not mandate or regulate that from the centre. We want to have a system where people can learn from each other.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Southern Cross Healthcare

Bernard Jenkin Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

I think we need a reality check. About 78% of care in the social care sector in England is provided in the private sector. That transfer to the private sector has not happened just in the past 12 months; it is the product of successive Administrations’ policies over many years. We must draw lessons from the experiences of the last few months, but we must focus on the paramount interests of residents and ensuring that this restructuring is successful. That is what I am focused on.

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

I thank the Minister for the information he has given the House and congratulate the hon. Member for Blaenau Gwent (Nick Smith) on his urgent question. There are two such homes in my constituency. This matter is of great concern not just to residents, but to staff. The impact on staff morale has an impact, in turn, on the care given to residents. I urge my hon. Friend to facilitate a speedy resolution as best he can, and to look at the model that we expect local authorities to adopt for buying care. Residents, their families and their advocates should be consulted more and be more involved in the process, so that care is more tailored and there are not such enlarged packages that can be exploited by large organisations, which may not be run as openly and transparently as they should be.

[Paul Burstow]

I am grateful to my hon. Friend for that important question, which points to the need for greater personalisation in the delivery of social care in the longer run. At the moment, in concert with our local authority colleagues, we must be clear about what happens in the event of failure, but also focus on ensuring that this business successfully ensures its future, and that of its employees and the residents who live in its homes.

NHS Reform

Bernard Jenkin Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

If I did not come to the House to make a statement, I would be accused of not doing so, but when I do so, the Opposition ask why. The reason is very simple: it is because we are going to listen, and to engage with people actively over the course of the coming weeks, and I did not want the House to see that happening during the recess without having been told about it beforehand.

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

Does my right hon. Friend agree that only the most cynical people could criticise him for wanting to consult more about the changes that he wants? [Laughter.] And that only the most cynical could treat the NHS as a laughing matter? Will he maintain the goal of delivering the prize, which is to give local people, through their local GPs, more control over the resources that the NHS spends in their name?

[Mr Lansley]

Yes, I agree. Indeed, in north-east Essex, the consortium under Dr Shane Gordon’s leadership is doing exactly that. I personally think that leadership and listening are not mutually exclusive, and we are going to continue to do both.