Health Professionals: Regulation

Charlotte Leslie Excerpts

Monday 4th March 2013 Commons Chamber

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

I thank my hon. Friend for his powerful and informative speech. Does he agree that what matters is not only ensuring that data are transparent for patient groups, but the quality of assessments, where we have seen a failure? Hospitals with obviously high mortality rates were deemed acceptable by assessors even before the fiddling of figures. Is that not partly because people not qualified to know the ins and outs of what goes on in, say, the operating theatre are going round, ticking the boxes and saying, “That’s all fine”, when in fact it is not? With the expert eye of another experienced clinician in the same field doing the assessment, very different outcomes would arise. It is because they have that knowledge and expertise that organisations such as the Royal College of Surgeons have been commissioned to carry out reviews.

[Stephen Barclay]

My hon. Friend is right. A lot of the people at the Care Quality Commission doing the clinical assessments are not clinically trained, and, even when they have a clinical qualification, it often does not relate to what they are looking at—for example, we might have doctors looking at baby units. Her point applies to coding as well: as seen in media reports last week, the people reinterpreting the coding are often not clinically trained.

Whistleblowers have a unique vantage point on what is happening with patient safety, but for too long we have hypocritically lauded their contribution publicly while silencing or gagging them in practice. The Commission for Health Improvement found problems at Mid Staffordshire back in 2002, a peer review of critically ill children by the strategic health authority criticised Mid Staffordshire in 2003 and 2006, and whistleblowers at Mid Staffordshire raised concerns as far back as 2005, yet the warning signs were not acted on. Many members of staff simply chose to close ranks. There appeared to be a bullying culture which discouraged people from coming forward, and those who did were threatened. One nurse at Mid Staffordshire summed up the position by saying:

“The fear factor kept me from speaking out”.

This is not an isolated case. It is almost beyond parody, but the Care Quality Commission, the body to which whistleblowers might turn, itself used gagging clauses. It disgracefully smeared Kay Sheldon, a member of its board. When she had the courage to speak out, it was suggested that she had mental health problems. That is the culture. As my hon. Friend the Member for Bristol North West (Charlotte Leslie) pointed out during Prime Minister’s Question Time last Wednesday, three reports commissioned to mark the 60th anniversary of the NHS in 2008 which identified problems appear to have been buried. One of those reports, to Ara Darzi, referred to a “shame and blame” culture, and said that fear was pervading the NHS and at least certain elements of the Department of Health. Why were those reports buried?

Figures I obtained after a two-year battle in Whitehall showed that £15 million of taxpayers’ money had been spent over three years to gag whistleblowers. Why are we spending £5 million a year to silence those who are brave enough to speak out? We hide behind the guidance which says that the Public Interest Disclosure Act 1998 protects them, but, as we have seen in the Gary Walker case, trust lawyers threaten and intimidate whistleblowers although they know about that protection. I welcome the Secretary of State’s recent letter, but I must point out that gagging clauses have no place in the NHS today.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) on securing the debate. He made a number of serious allegations, but he was absolutely right to say that it is completely unacceptable to manipulate any patient information deliberately in order to falsify reports of a trust’s performance, and there will be serious consequences for any part of the NHS that is found to be doing so. He was right to say that if we are to have an open and accountable NHS in which patients and the public know how hospitals are doing, the hospitals must be open and honest about their performance.

My hon. Friend was also right to say that we want the NHS to have the lowest mortality rates in Europe. Sir Bruce Keogh, the NHS medical director, is currently leading an investigation into hospitals with higher mortality rates to understand why they are higher and whether they have all the support they need to improve. To pick up on the point that my hon. Friend the Member for Bristol North West (Charlotte Leslie) raised in her intervention, that will involve senior clinicians with background expertise going into those hospitals to ensure that proper scrutiny is brought to bear.

[Charlotte Leslie]

Will the Minister give way?

[Dr Poulter]

I will, very briefly, although my hon. Friend did not notify me previously that she intended to intervene.

[Charlotte Leslie]

I thank the Minister for his courtesy and apologise for not notifying him in advance. Does he have any indication of where our current mortality data lie in relation to comparable countries and, if not, will he speak with Sir Brian Jarman of the Dr Foster website, because I believe that he has some rather depressing news on that front and it is probably time to start speaking the truth about that as well?

[Dr Poulter]

I thank my hon. Friend for her intervention. We have made it clear, both in opposition and in government, and indeed in the health care mandate, that we do not find it acceptable that Britain, compared with some other European countries, is not doing well when it comes to survival rates for a number of diseases, including some types of cancer and some respiratory diseases. We all know that the NHS must achieve more in that regard. It is not necessarily an isolated issue that applies to one particular trust. That is why we made it a priority in the NHS mandate set by my right hon. Friend the Secretary of State for Health at the end of last year, but the priority should be clinical outcomes, and a key priority is improving mortality for a number of diseases, particularly those that are attributable to patients with long-term conditions.

I thought that it might be worth discussing in more detail a few of the points my hon. Friend the Member for North East Cambridgeshire raised. He talked in particular about the Francis report. For everybody who cares about the NHS and works in it, as I still do, the day the Francis report was published was a humbling one. There was failure at every level: a systemic failure, a failure of regulation, a failure of front-line professionalism, a failure of management and a failure of the trust board. There are systemic problems with the NHS that we need to focus on and address. That is what my right hon. Friend the Secretary of State will outline when we give our further response to the Francis report later this month.

My hon. Friend the Member for North East Cambridgeshire was also right to highlight that there has been too much covering up in the past and not enough transparency. If we are to put right some of the systemic failings highlighted in the Francis report, we need to be grown up enough to acknowledge that sometimes the NHS does not come up to standard and the care that we would expect to be delivered to patients is not always good enough. If we care about our NHS, and if we want an NHS we can continue to be proud of and that will continue to be the envy of the world, we must acknowledge when things go wrong and ensure that we face up to the problems in an open and transparent way. We must ensure, as many hospitals with a more transparent culture do, that good audit and proper incident reporting are in place for when things go wrong. We must ensure that, rather than having recriminations and closed doors, bad things are learned from, and that where things have gone wrong and patients have not been treated properly, hospitals and the whole the NHS make more active efforts to deal with problems and failures of care.