Managing Risk in the NHS

Charlotte Leslie Excerpts

Wednesday 17th July 2013 Commons Chamber

[Charlotte Leslie (Bristol North West) (Con)]

The Opposition often say that we need to learn lessons—in many ways, I agree with them—and so I intend to go through some of the lessons we can learn. I note that on the 65th anniversary of the NHS, Labour made cupcakes saying, “We love the NHS”, which prompts an interesting question: do we love the NHS—the institution—or do we love, care for and want to protect the patients it serves and respect the professionals who work in it?

I was also very perturbed yesterday by the venom in the denial of some—not all—Opposition Members. As I said then, it reminded me that Julie Bailey faced the same venom and aggressive denial in response to her mission to try to expose some of the truths at Mid Staffs. I am equally perturbed and disturbed that a lot of that venom is coming from two Labour party members locally, Diana Smith, who used to work for David Kidney, and Steve Walker. I would very much like to know whether the Labour party will formally condemn those actions.

The shadow Secretary of State mentioned rewriting history, and I am also slightly concerned that there was a little rewriting of history or confusion in that state of denial. I remind him that it was not him who commissioned Francis 2. He commissioned Francis 1, which was an inquiry of far more limited scope where evidence was given behind closed doors. He had every opportunity to commission Francis 2, and if he had done so the lessons he is now saying we must implement more quickly—and I appreciate speed is always of the essence—could have been implemented some time ago.

[Andy Burnham]

I would like just mildly to correct what the hon. Lady said. When I commissioned Francis 1, I said to Robert Francis that if he did not think he was receiving enough co-operation from witnesses in the first-stage inquiry and he came back to me wanting me to give him powers to compel, I would be glad to give him those powers. The second point the hon. Lady needs to bear in mind is that when he delivered his first report I told this House, in February 2010, that I would be commissioning a second stage report looking at the wider regulatory issues.

[Charlotte Leslie]

That is very encouraging to hear post-event, but unfortunately it still leaves some questions as to why the Cure the NHS group was not able to go along and formally deliver the case studies of Bella Bailey at the Department of Health but instead had to go and see the former Secretary of State outside his constituency office—and for those who want to deny yet more evidence, that is on YouTube.

We have to ask why this review was not commissioned at the time if there were, through 81 requests, serious concerns raised. What did people have to hide? In 2009 the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) said fairly clearly that Mid Staffs was a one-off, but unfortunately we know from the Labour “lines to take”—which are in the inquiry so are in the public domain—that Labour knew there were 12 hospitals with equal or even worse mortality rates. That was denied, but, tellingly, that brief says Labour should try to avoid naming them. That stands in stark contrast to the approach taken in the Keogh report, which has been transparent in naming those trusts where there are problems. Unlike Labour, I do not think being honest about the situation prevents improvement; actually, I think it helps improvement.

[Charlie Elphicke]

I congratulate my hon. Friend on making such a powerful speech. Does she agree that we have got to put patients first? If we put institutions first, and if we worry about staff and staff morale and how they might feel about things, we will inevitably slide in the direction of having a culture of sweeping things under the carpet and—dare I say it—covering things up. Unless we put patients first, we will not ensure there is a proper, sensible culture in our health service.

[Charlotte Leslie]

I absolutely agree with my hon. Friend. I would draw a distinction, however, as I think many members of staff in the NHS want, and wanted, nothing more than to put patients first. I was slightly surprised that only two Opposition Members mentioned patients and patient safety in their contributions yesterday. That was very upsetting.

[Frank Dobson]

In reference to the point the hon. Lady made to the previous intervention, does she agree with Professor Keogh—a most excellent man—that there is a strong correlation between the extent to which staff feel engaged and mortality rates, thus indicating that caring about staff is absolutely crucial if we are going to care about patients?

[Charlotte Leslie]

I absolutely agree, although there is a distinction to draw between managerial staff, who I think have been leant on heavily to make their hospital look good, and the ground-level staff, many of whom have been battling over the last decade to be able to put clinical priorities ahead of management and political priorities.

[Grahame M. Morris]

Will the hon. Lady give way?

[Charlotte Leslie]

I am going to make progress, if I may.

I am surprised when many on the Opposition Front Bench talk about the welfare of staff, because one of the things Labour did that was so disastrous was take the medical royal colleges out of inspections. That happened after one hospital in particular was found to be lacking. Alan Milburn at the time—in the early 2000s—removed the medical royal colleges from the inspection regime, and did so perhaps, we have to ask, because they might come up with some very unpleasant truths. I am delighted that the Secretary of State is looking to reverse that decision in respect of those who know and will give Governments of all colours a good kicking if things go wrong.

There has also been, unfortunately, a culture of cover-up—I would love to be proved wrong on this; there is still time, there is information that I am still seeking, and anyone can come to me with it—about the three reports that were commissioned on the 60th anniversary of the NHS. The right hon. Member for Leigh shakes his head but I would very much like to meet him to see whether he can show me the minutes of the meetings which he must have attended, at which these reports were discussed. [Interruption.] I will make progress while he talks at me from the Opposition Benches.

It is ironic that on the 65th anniversary we have cupcakes. On the 60th anniversary there were three reports which warned, I remind Members, of a culture of fear and compliance—that sounds familiar; hitting the target and missing the point, which also sounds familiar; and inadequate regulation and inspection. Goodness me, doesn’t that sound familiar? The reports were exhumed only after freedom of information requests. I have put freedom of information requests to the Department of Health which, oddly, have been obstructed. I seek the help of the Secretary of State and of the shadow Secretary of State, if he would like to set the record straight, in seeking information. Who was present at those meetings where those reports, which cost the taxpayer £500,000, were discussed? They were by international experts, including Don Berwick, whom we are now putting at the centre of our NHS on the zero-harm strategy.

[Grahame M. Morris]

Will the hon. Lady give way?

[Charlotte Leslie]

I am terribly sorry. I will make progress.

I would also like to set the record straight on who knew what about hospital trusts. The right hon. Member for Leigh says that he took astute action. He knows, because I have the e-mails, as he does, that he was written to by Professor Sir Brian Jarman about 25 trusts about which he had concerns. He said he was concerned that the CQC was not doing its job. Seven of those were investigated by Sir Bruce Keogh. Fifteen of those trusts were in marginal seats and one, as he will know, was in the constituency of the right hon. Member for Leigh.

[Andy Burnham]

That list, when Brian Jarman gave it to me, was immediately referred to the CQC. Within weeks, six of the trusts, I think, on that list were registered with conditions before the general election.

[Charlotte Leslie]

The fact that the very same trusts appear in the Keogh report and have not resolved their problems proves that we have suffered a legacy issue. Those reports are still relevant.

The then Secretary of State referred those trusts to the CQC, which we now know he was leaning heavily on. We know that people were saying that the aim of the CQC’s operation was that no bad news should come out. The lessons that we need to learn about how to avert risk and to care for patients is to return to the specialist, honest medical analysis and inspection of hospitals that will give all Governments some uncomfortable truths. This party wants to hear uncomfortable truths. We do not want to smother them.

Labour has presided over a culture of bullying, threatening and aggressive denial, which we sometimes see in the Chamber. We will not be bullied now. The truth is out. Finally, patients and professionals struggling to care for those patients will not be stifled under a saccharine sickly-sweet cupcake icing which says, “We love the NHS”. We have seen in so many tragic cases that that love has been lethal.

--- Later in debate ---

[Dr Phillip Lee (Bracknell) (Con)]

The title of the debate, “Managing risk in the NHS”, is very important. Indeed—although this may not be a topic for today—we ought to start thinking about the whole concept of risk and what patients will accept in terms of risk, especially given that everyone now has access to information via the internet. Invariably, the first thing someone puts into Google is the thing they are least likely to be suffering from as a consequence of the symptoms they are experiencing, so it is extremely important that risk is discussed much more with the patient population. As the right hon. Member for Holborn and St Pancras (Frank Dobson) said, it is extremely difficult to be a GP and to try to manage the demands being placed on the health service when people are coming in thinking that their headache is a brain tumour and so on.

It is particularly appropriate that I am speaking in this debate, because today the Care Quality Commission has published a report on Heatherwood and Wexham Park Hospitals NHS Foundation Trust. I am surprised that the hon. Member for Slough (Fiona Mactaggart) has not taken the opportunity to speak in this debate as a consequence. The report highlights significant concerns about the trust and the care of patients. None of the concerns was news to me: I approached the then Health Secretary about them in June 2010; I spoke to Monitor, whose chief executive told me, remarkably, that he had no concerns whatsoever and nothing had come across his radar about the trust; and I also spoke to Cynthia Bower in September 2010 about them. I say that because Monitor and the CQC were clearly not fit for purpose and doing their job of finding out what was wrong with hospitals.

I recognise the current Secretary of State’s desire to have a chief inspector of hospitals, and I wholeheartedly support him on that concept. However, I counsel colleagues on both sides of the House that if we start looking properly at the performance of hospitals, we will, judging by the list of experiences that the right hon. Member for Cynon Valley (Ann Clwyd) has just shared with the Chamber, have plenty more stories to deal with about hospitals, and how they fail or are failing.

I wish to concentrate primarily on legacy and the genesis of these problems, which probably blight both parties. A hospital does not suddenly become a problem in the space of a couple of years; that can occur over a number of decades. The problem we have in this country is that a large number of our hospitals are not fit for purpose. There is a legacy of poor location, not only because the land was often bequeathed, but because the buildings are often not fit for purpose. That is the particular problem at Heatherwood, and with its theatres, as was highlighted in the CQC report.

There is also a legacy in respect of the district general hospitals in general. They have had their day and we do not need them any more; we need regional specialist hub hospitals such as the one I have been proposing for the Thames valley for the past three to four years. I say that because if we are trying to provide care, it is incredibly difficult to mitigate risk when the theatre is not fit for purpose or when the hospital cannot be staffed appropriately. Labour Members have made much mention of nursing numbers, but the issue is much bigger than that; it is about the quality of the clinicians. Most clinicians have to specialise and sub-specialise, and the only way in which we will be able to provide the very best care in the 21st century is by having fewer acute hospitals. All the royal colleges share that opinion; I am not cornering that market. The flip side, however, is that we will have more community hospitals and more community care, which can only be a good thing.

If I were allowed to advise Members, I would tell them to be cautious on the issue of end-of-life care, because it will be extremely difficult to provide that in an increasingly ageing society. We are going to have some very difficult decisions to make for people in their 90s and for people over 100. There is no easy solution to this. The Liverpool care pathway was probably an honourable approach to try to take. I am not saying that it was perfect, but there was a desire to do the right thing in its implementation.

The reconfiguration is necessary and, for it to be appropriate, it will need cross-party support. We are not going to get anywhere by trading insults and taking political positions over various hospitals. Quite a few hospitals are not fit for purpose, with some in Conservative seats, some in Labour seats and some in marginal seats. If those of us who are interested in this topic truly want to improve care for all, we really need to remove party politics from the reconfiguration debate and engage in a cross-party discussion about where these hospitals should be. If we did that, if we managed to build some new hospitals—I suspect that we will have to build quite a few, because, as I said, the problem with a number of established hospitals is that their locations are inappropriate, as is certainly the case in my part of the world—and if we could come to a consensus and some agreement on this, we would be bequeathing to future generations a hospitals sector to be proud of. We do not have one to be proud of, however. We heard that mortality rates have been going down, but of course that is the case, because we are getting better at medicine, but with that come challenges regarding the end of life.

[Charlotte Leslie]

Does my hon. Friend have any information about how Britain’s reducing mortality rate compares with that of comparable European countries?

[Dr Lee]

I do not have such information to hand, but it would be interesting to compare our mortality rates for various conditions with those of Germany, Holland and France over the past seven to 10 years to determine whether there has also been a decline in those countries. It is difficult to claim that it was just the investment of money that led to reduced mortality rates in this country. I do not rule out the fact that the investment was a factor, but I suspect that the decline was due to advances in medicine and technology, and indeed in the skill base of consultants.

If we reconfigure, consultants will have a larger throughput of patients. It is interesting to note that Tameside covers about 175,000 patients—not enough—that Basildon and Thurrock covers about 300,000 or so, and that Mid Staffs covers about 225,000. Hospitals should cover a minimum of 500,000 people, if not 750,000, if they are truly to deliver the best acute and surgical care. The staff, especially the consultants, will want such a throughput of patients so that they can maintain and enhance their skills, and thereby improve mortality statistics. I therefore conclude by begging the Government and the Opposition to take the party politics out reconfiguration so that we can secure a hospital sector of which we can be proud for the next five decades.