Care Bill [Lords]
Charlotte Leslie Excerpts(10 years, 7 months ago)
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Andy Burnham
They did, and they put those posters up at the election to try to scare older people—I do not know how they thought that was appropriate, in the same way I do not know how their contributions today have been appropriate.
What my hon. Friend the Member for Coventry South (Mr Cunningham) says is exactly what is happening. People are not daft. They can see what is going on. They saw a Government legislate to place the market at the heart of the NHS in a way that means we now have the Competition Commission making decisions and forcing services out to open tender. We also have a Secretary of State who does not waste a day running down the NHS—“uncaring nurses”, “lazy GPs”, “coasting hospitals”; everything undermined, everything wrong—rather than celebrating good care. That is the agenda. They are softening the NHS up for more privatisation.
That will be the big choice come the next election. The Secretary of State can spin whatever lines he wants from that Dispatch Box, but that is the choice: a public, proud NHS under Labour, or a fragmented market under the Conservative party. I know which side of the debate I am on, and that is the choice we will put to people.
Charlotte Leslie (Bristol North West) (Con)
Independent sector treatment centres—the right hon. Gentleman’s party started competition!
Andy Burnham
Across the NHS, people are spending millions on competition lawyers thanks to the Bill that the hon. Member for Bristol North West (Charlotte Leslie) and others passed. That is being cited as the major barrier to the integration that the Secretary of State claims he wants. Let me quote the NHS chief executive to back up that point. He recently told the Health Select Committee:
“What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost in the system and great frustration for people in the service about making change happen… In which case, to make integration happen we will need to change it”.
By which he meant the Health and Social Care Act. It could not be clearer. It is the biggest barrier to the integration of care and support for older people. That is understood across the NHS, but the Bill does nothing about it.
Instead, the Government have left an NHS bogged down in competition law. How did it come to that? Who voted for that change? Who gave this Prime Minister and this Health Secretary permission to do something that Margaret Thatcher never dared—put the NHS up for sale? The answer is no one. Ministers talk the talk about integration, but they have legislated for fragmentation and privatisation, and the Bill does not change that. Only Labour will repeal the Health and Social Care Act, and that will be the big choice, as I say. We will bring health and care together, creating a public service working for the whole person. That is the only way we can reshape health and care services around individuals in their own homes.
In conclusion, the Bill makes some sensible changes that we will not oppose, but as our reasoned amendment makes clear, it falls far short of the durable solution that England needs. Social care in England is getting worse, not better, and the Bill does nothing to change that. It will not stop people having to lose their homes and savings to pay for care, and in the end it deceives older people about the amount they might have to pay for care, which is fundamentally wrong. Older people deserve better, and it will fall to Labour to have the courage to deliver it.
Charlotte Leslie (Bristol North West) (Con)
I greatly welcome much of what is in the Bill. I am slightly disappointed by the tone of some—not all—Labour Members, who seem to suggest that the challenges our society faces with social care are in some way new. I looked after an old lady from 2003, during the economic boom times, and became very well acquainted with her care package, care needs and care challenges, and the challenges faced by her social workers. Back then, social workers were expected to get across London in 20 minutes, which was obviously impossible, so the care time that they had with my friend was severely cut down; in fact, sometimes it was 15 minutes, a figure that we have already heard. There was also a massive challenge in terms of raising the status of the profession of social work. Those challenges existed back then, during the boom times, and they still exist now. It is very brave and ambitious for the Government to be making such significant steps in unifying health and social care at a time when the economic situation is very difficult.
Other Members have dealt with the care and support aspect of the Bill more eloquently than I can, and I am sure that others will too. I want to focus my brief remarks on part 2, which is about the response to Francis and care standards.
I think that one lesson we have learned following the Mid Staffs scandal is that making rules does not necessarily mean making change. I remind the House of the 2002 “Code of Conduct for NHS Managers”, which states:
“As an NHS manager, I will observe the following principles: make the care and safety of patients my first concern and act to protect them from risk;…be honest and act with integrity; accept responsibility for my own work and the proper performance of the people I manage”.
Following the unravelling of scandals in Mid Staffs and elsewhere, it is very hard to understand how NHS managers were adhering to that code of conduct, which was written for them, and why none of them has faced the consequences of not doing so. That is a salutary lesson: we need to be wary that putting things in writing does not always mean that they will happen culturally. People have remained unaccountable for a serious breach of that managerial code of conduct, many of whom, I am afraid to say, continue to work in the NHS today.
As the Bill progresses, I want to see more detail on how the contractual obligation for a duty of candour, which is welcome, will be enforced. I understand the desire for a statutory duty on individuals, but I share fears that it may oversimplify the blame culture that this House has discussed at length. Having seen what happened with our hospitals’ complaints system and the cover-up of blame, I am very worried that a statutory duty on an individual clinician could be abused, such that blame could be parked at a clinician’s door by a management system that does not want its own failings to be highlighted. That could lead to unfortunate false allocations of blame by the system in which clinicians work.
If a contract’s duty of candour is not met, what will be the consequences? It is an issue that there have been no consequences for those who have breached things written down in guidelines and codes of conduct. It is important to understand in more detail what the consequences will be of a breach of contract.
I would particularly like to know whether managers, organisations such as NHS England, and Department of Health officials will have the same duty of candour. The reason why scandals such as Mid Staffs have been allowed to go on and on is that it was not just the hospital that was complicit in it; the entire system around the hospital should have been acting in patients’ interests, but it did not.
Some have faced consequences for their actions—their actions were good, but the consequences have been diabolical—namely whistleblowers. I know and understand that real reform of how we treat whistleblowers and enable whistleblowing will require changes to the Public Interest Disclosure Act 1998. If a whistleblower has been found to be correct in raising concerns in the NHS and those concerns are recognised, I would like to know why any future employer would choose not to employ them. If an employer is a good employer, they would welcome a whistleblower into their ranks as someone who would not go native and accept appalling care when others might do so and who would also have the moral fortitude to stand up and talk about failings when others might not. The test of a good employer is how well they employ people who have been proven to be whistleblowers.
People such as Eileen Chubb and David Drew have sacrificed their careers to highlight bad care, but they have not seen the systemic changes for which they made those sacrifices and they are still suffering the consequences. Surely that is a part of NHS and health culture that the Bill should seek to change.
I welcome the fact that the Care Quality Commission will be looking at the issue of whistleblowers and I welcome James Titcombe’s involvement in the CQC. As someone who thought that the CQC brand was so damaged that it should probably just be scrapped and we should start again, I have to say that I think David Prior has made remarkable progress, given what he started out with, in beginning to turn this monolith around.
Statutory independence of the CQC is very long overdue. I think that everyone in the House has been concerned about the fact that the CQC’s mission seemed to be reputation management for itself and the NHS, and not a brave and courageous stand on behalf of the patients it was supposed to be protecting. In order to ensure that the CQC remains independent from Government—independence in words is fine, but independence in culture is what really matters—it might be illustrative to look back to the era before the CQC and other regulatory bodies were in place, when royal colleges used to send their members into hospitals. They would do so not to inspect hospitals as such, but for reasons of medical training. However, by getting a granular view of the training on offer they could see whether or not it was sufficient. If not, the royal colleges could, under bodies such as the hospital recognition committee, withdraw training from a hospital, which gave the inspection teeth. It was the royal colleges that went in—often without any pay at all; just enough to cover expenses—and interviewed junior doctors and consultants individually, and problems naturally came to light because the interviews were often confidential.
A Wigan hospital fell foul of an inspection in 2001 and its chief executive did not take kindly to it. Funnily enough, just after the inspection took place, the chief executive, who was quite close to Alan Milburn and the then Prime Minister, went into the Department of Health and abolished the system whereby professional clinicians could get a granular view of what was going on in hospitals, replacing it with the postgraduate medical education training board and then the medical training application service, which was disastrous. The more we can put those who do not have an interest in bolstering the Government of the day—namely the professionals, clinicians and members of the royal colleges—on the ground and doing granular investigations, the more confident we can be that the CQC will be independent.
Grahame M. Morris
I am not sure that I share the hon. Lady’s enthusiasm about the transformation of the CQC; nevertheless, some progress has been made. Does she share my concern that clause 85 proposes to dilute the CQC’s powers with regard to investigating the commissioning of adult social services and social care by local authorities? Is that not a step backwards, particularly if the hon. Lady is concerned about the issue of 15-minute visits and the impact that has on quality?
Charlotte Leslie
I am afraid that the quality of care and social care could be the next boil of scandal to erupt as we gain a more granular view of what is going on. Organisations need not just more effective tick-box inspections, but more effective granular inspections. I do not agree with the hon. Gentleman: I think the CQC is taking great steps forward. I am very sceptical, but I am cautiously optimistic of progress and will continue to look at what the CQC does.
I will make progress, because I do not want to prevent other Members from contributing to the debate. Essentially, the Bill can only put down regulation. One of my favourite things is to warn against systems so perfect that nobody needs to be good, yet this House really only has levers to change systems. We cannot always enable people to be good, but we can devise systems that enable them to be good. This House is attempting to turn around a massive cultural tanker and it is unrealistic to think that we can do so through the scope of a single Bill. I think, however, that the Bill takes very important steps forward in a very difficult context. I am disappointed that it is not supported throughout the House, although I think that constructive amendments and changes to it will be welcomed in the interests of the patients we are all here to serve. I heartily recommend the Bill to the House.
Oral Answers to Questions
Charlotte Leslie Excerpts(10 years, 9 months ago)
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Mr Hunt
I am pleased to tell the right hon. Gentleman that we are working closely with the police to try to ensure that some of the people held in police cells are given much faster access to mental health services. That includes a street triage pilot, which has had early and promising results.
Charlotte Leslie (Bristol North West) (Con)
I was informed this morning that the chair of the NHS property board has resigned. That follows the revelation last week, through parliamentary questions I asked, that the board has been raiding its capital allocation to subsidise its own revenue funding. In the interests of transparency, will the Secretary of State undertake to review and publish the recruitment and employment procedure of executive and non-executive members of the board—including civil servant Peter Coates who created the board, which oversees £3 billion-worth of assets—and conduct careful audit and scrutiny of the board’s accounts and minutes?
Managing Risk in the NHS
Charlotte Leslie Excerpts(11 years ago)
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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.
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.
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.
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.
Oral Answers to Questions
Charlotte Leslie Excerpts(11 years ago)
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Mr Jeremy Hunt
The hon. Lady asks that question as if that kind of thing never happened under Labour. The answer is that it is not acceptable, which is why we are changing the rules to ensure that people cannot get payoffs and then walk straight into another NHS job. The other answer is that the reorganisation that she criticises means that we have put more money on the front line, including for 6,000 more doctors, which I think was the right thing to do.
Charlotte Leslie (Bristol North West) (Con)
Does the Secretary of State agree it is a scandal that those, such as Gary Walker, Amanda Pollard and Kim Holt, who have exposed the horrors buried in our NHS have either been fired or do not have jobs, but those who are heavily implicated in such cases, such as Barbara Hakin—about whom I have written to the Secretary of State—David Nicholson, and others, still do?
Mr Hunt
My hon. Friend has campaigned long and hard on issues of accountability, and I agree with her basic case, even if I do not agree with her about all the individuals she mentioned. One issue that will arise during today’s statement is that of how people are held accountable. That has been missing in our NHS, and we must put it right.
Hospital Mortality Rates
Charlotte Leslie Excerpts(11 years ago)
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Mr Hunt
It is, absolutely. That is the big change. My hon. Friend speaks wisely. That is the big change that we have to make in our NHS. When there is failure, we must be open about it. It has to be public—we have to keep the public in the picture, because that is the best way of putting pressure on the system and on the politicians to make sure that they sort it out. That is not what happened before; it is going to happen now.
Charlotte Leslie (Bristol North West) (Con)
Does the Secretary of State share my dismay that just as Julie Bailey was hounded out of Mid Staffs by the local Labour party for revealing the truth, some of the tone of this debate—accusations, sanctimoniousness and false victimhood—is a very tangible illustration of what whistleblowers have had to face for the past decade when they have tried to get the truth out? What a tangible demonstration, sadly, this has been.
Care Quality Commission (Morecambe Bay Hospitals)
Charlotte Leslie Excerpts(11 years, 1 month ago)
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Charlotte Leslie (Bristol North West) (Con)
I echo the sentiments of the right hon. Member for Exeter (Mr Bradshaw) and ask the Secretary of State to look urgently at the application of the Data Protection Act if accountability is to mean anything at all. I urge him also to look at the lessons that a change of leadership effected in the CQC and the era of transparency that that heralded. There is a cover-up which is not just about Morecambe Bay; it is about Mid Staffs, and I suspect that, sadly, other stories may emerge of other such horrors. Does my right hon. Friend think there should be an inquiry into the culture of lack of transparency and cover-up that involved senior managers, and will he consider a change of leadership in order to herald a proper culture change in the NHS?
Mr Hunt
My hon. Friend has campaigned with great assiduity and distinction on this issue. The report about the culture of cover-ups and secrecy was the Francis report, and my job now is to do what is necessary to bring forward the change so that we move on and have a culture of openness and transparency. That means, yes, openness and transparency in this place and among Government Departments and regulators, but it also means creating a culture for front-line staff where they feel that they can raise concerns. We do not do that as well as we should, and it is even more important.
Oral Answers to Questions
Charlotte Leslie Excerpts(11 years, 1 month ago)
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Anna Soubry
Well, it is a very good point, and the hon. Gentleman knows my own feelings. [Laughter.] No; it is important that we always get the balance right between good public health measures and not getting the accusation from both sides of being a nanny state. [Interruption.] No, no; it is all right his getting agitated, but he knows my view, and I am happy to give him any assistance I can—my door is always open.
Charlotte Leslie (Bristol North West) (Con)
Does the Secretary of State agree that any criminal investigation into the 200 to 300 deaths at Mid Staffs should extend not only to front-line staff, who risk getting scapegoated, but to all managerial levels, Department of Health officials and the heart of Government, so that we get answers about who knew what and when, and what action they took or—more importantly—did not take that could have prevented this tragic scandal?
Mr Jeremy Hunt
I congratulate my hon. Friend on her determined campaigning on this issue. She will agree that we must allow the law to follow its course. The police are looking at the five reports on hospital safety that were undertaken, the inquests and the lists of patients who appear to have been treated badly, and they are talking to the relatives of those patients. We must allow them to do their work, but no one is above the law, and particularly in this case it is important that justice be done.
Mid Staffordshire NHS Foundation Trust
Charlotte Leslie Excerpts(11 years, 3 months ago)
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Charlotte Leslie (Bristol North West) (Con)
I very much welcome the Secretary of State’s statement, but does he share my sorrow that it has taken so long and so many deaths to reach this stage, when Labour was presented with reports by Don Berwick himself highlighting bad quality assessment, when 120 bodies had overlapping responsibilities and when he said that patient safety was not central to the NHS? Is it not tragic that it has taken this long?
Accountability and Transparency in the NHS
Charlotte Leslie Excerpts(11 years, 4 months ago)
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Charlotte Leslie (Bristol North West) (Con)
I beg to move,
That this House believes that in the wake of the Francis Report it is clear that accountability and transparency are of paramount importance to patient safety and trust in the NHS; and further believes that across the NHS individuals found to have breached those principles should face the appropriate consequences.
I would first like to thank the Backbench Business Committee for granting the debate; I realise that it did not have much time left to allocate in the Session and so am particularly grateful to its members for giving the House the opportunity to debate this timely and important issue. I would also like to thank all the Members who supported the motion, particularly my hon. Friends the Members for North East Cambridgeshire (Stephen Barclay), for Bracknell (Dr Lee), for Totnes (Dr Wollaston) and for Southport (John Pugh) and the hon. Member for Vauxhall (Kate Hoey). I must also thank all those who have contacted me, including the Patients First group. I am sorry if we are unable in the time available to do justice to all the information we have been given, but rest assured that this is the beginning of the scrutiny, not the end.
This debate is neither about playing party politics, nor about only the future of one man, David Nicholson; it is about transparency, and about a deadly cover-up in our NHS and how we can ensure that never happens again. As one concerned former nurse wrote to me:
“Please don’t let me read those meaningless words, Lessons Have Been Learned”.
It sometimes seems that politicians can dodge taking responsibility so long as they say quickly enough that “lessons have been learned”, but learning lessons is not the same as simply uttering a phrase. The truth must be revealed, and consequences faced, if accountability and transparency are to be anything more than just words.
Let me make it clear that refusing to play party politics is not the same as letting people evade responsibility and that statesmanship is not the same as letting people off the hook. We owe it to those outside this Chamber. We owe it first and foremost to those patients who were, in some instances, killed in our hospitals, and we owe it to their grieving families, for whom no amount of politicians saying that “lessons have been learned” can bring back their mum, dad, sister, brother, child or friend.
After patients and their families, we also owe it to those dedicated doctors and nurses who were struggling to raise the alarm against a system that systematically suppressed their concerns. Many of them retired early in protest at what they were being asked to do, and some of them tried whistleblowing and were met not with thanks from the authorities, but intimidation and gagging. We will hear about some of that later.
I must congratulate the Prime Minister and the Secretary of State for Health on their appointment of Don Berwick to ensure that the basic requirement of “Do no harm” is embedded in health care. Don Berwick, an adviser to President Obama, is an internationally renowned authority on health care. The Institute for Healthcare Improvement, which he co-founded and chaired for 21 years, is a world-leading centre of medical improvements based on proven success. I am delighted that the Prime Minister has put him right at the heart of improving our health care system.
The tragedy, however, is that Don Berwick’s wisdom and recommendations are not new; they have been delivered before. They were delivered to the previous Government in no uncertain terms back in 2008, when David Nicholson was chief executive of the NHS. Instead of implementing them urgently, the previous Government were uncomfortable with what they revealed about their NHS, so they decided to suppress those truths. They suppressed a report by Don Berwick and his institute along with two other damning reports by international experts—RAND and Joint Commission International—that contained burning recommendations to be implemented with all urgency.
Alan Johnson (Kingston upon Hull West and Hessle) (Lab)
If the hon. Lady turns to page 1,281 of volume 2 of the Francis report, she will see that, far from the reports being suppressed, every one of them was seen by Robert Francis. He states:
“As part of his work leading the working group, Sir Liam”—
Sir Liam Donaldson, the former chief medical officer—
“commissioned reports from three highly respected US-based organisations”.
Francis concludes that section by stating:
“Indeed it is clear that the NSR”—
the next stage review, the Darzi review—
“sought to address many of the concerns raised in these reports.”
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Before the hon. Lady responds—[Interruption.] I am sorry, but does the Opposition Whip have something to say?
Mr Deputy Speaker
Thank goodness for that.
We need short and concise interventions, because many Members wish to speak and I do not want to have to reduce the time limit further, but that is what will happen if we are not careful.
Charlotte Leslie
I congratulate the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) on seeking to defend his Government’s record. I will address his point fully later in my speech.
Don Berwick’s report was commissioned by Ministers, led by Lord Darzi and with the support of David Nicholson, to celebrate the 60th anniversary of the NHS. It states:
“The NHS has developed a widespread culture more of fear and compliance… It’s not uncommon for managers and clinicians to hit the target and miss the point”.
It highlighted the inadequacy of quality-control mechanisms in the NHS, stating that the priorities that are emphasised by these assessments are
“seen as being motivated by political rather than health concerns”.
It also highlighted the anger felt by many conscientious medics at Government changes to their employment and at being pressurised to put targets ahead of patients:
“The GP and consultant contracts are de-professionalising... Far too many managers and policy leaders in the NHS are incompetent, unethical, or worse.”
The report warns that
“this… must be alleviated if improvement is to move forward more rapidly over the next five to ten years.”
But those warnings were ignored, and we know that the improvements never happened. The report’s conclusion on a decade of health care reform is that
“the sort of aim implied by Lord Darzi’s vision…is not likely to be realised by the 1998-2008 methods.”
Don Berwick’s report was not alone; let me reveal what the other two reports said. They referred to
“the pervasive culture of fear in the NHS and certain elements of the Department for Health”
and stated:
“The Department of Health’s current quality oversight mechanisms have certain significant flaws”.
Perhaps the most damning indictment of all is that the politicians are responsible:
“This culture appears to be embedded in and expanded upon by the new regulatory legislation now in the House of Commons.”
Instead of being acted on with urgency, this was all buried. We know of the existence of Don Berwick’s report and the other reports only because a medic was so concerned that Berwick’s warnings and solutions had been buried that he tipped off a think-tank, Policy Exchange, which had to use a freedom of information request to bring them to public light in 2010, two years later. They were not even available to the Health Committee.
Let us get one thing clear. The NHS is a huge, monolithic organisation with an exceptionally difficult and, some might say, almost impossible task. In reality, things will go wrong, sometimes very wrong. The crime is not so much that things were going wrong, bad as that is, but that instead of immediately focusing on tackling it, the priority was to cover up an awful truth that was uncomfortable for Ministers and chief executives. All too often, Dispatch Box appearance mattered more than the reality of patients’ lives, leaving whistleblowers and patient groups such as Julie Bailey’s, which was disgracefully dismissed by David Nicholson as a “lobby group”, screaming into a vacuum, often at great personal cost. The crime is the smothering of the truth which costs lives—the deadly silence.
What was the cost of suppressing Don Berwick’s urgent prescription for the NHS? The clinical director of NHS Scotland recently suggested that in following Don Berwick’s recommendations it has experienced an estimated 8,500 fewer deaths since January 2008. We may well ask what was the cost in lives for our NHS of the previous Government’s decision to bury the truth. Across the 14 trusts now being investigated as well as Mid Staffs, there were 2,800 excess deaths between the time that the reports by Don Berwick and others were presented to Ministers and their final revelation in 2010. If the previous Government had been urgently implementing Don Berwick’s recommendations for those five years, who knows how many of those lives might have been saved?
How was this allowed to happen? I have put in freedom of information requests asking what meetings took place to discuss the reports and who was present. Although David Nicholson was working closely with Lord Darzi on the next stage review, he said in front of the Health Committee that, incredibly, he
“knew nothing about the reports”.
That is the Select Committee, so we must take him at his word. The question that then remains is who did read and suppress these vital reports. Was it Ministers? Was it officials? If officials, how was this allowed to happen? If the Department of Health is to move away from a culture of cover-up, I expect a full and accurate response to my request to know who was responsible, and I ask the Secretary of State to assist me in that.
Former Labour Ministers will complacently say, as they already have, that these reports fed into Lord Darzi’s next stage review and informed the report, “High Quality Care For All”. I ask the House whether a document that starts with the then Secretary of State, the right hon. Member for Kingston upon Hull West and Hessle, beamingly saying
“On its 60th anniversary the NHS is in good health”
reflects the content of the reports that we have just heard about. It certainly does not. Indeed, while the Department of Health claims that it “drew heavily” on the three reports in putting together “High Quality Care For All”, a source close to the authorship of those reports said that they found that claim to be “disingenuous at best”. David Flory, the deputy chief executive of the NHS, later told the Francis inquiry that he at least had some responsibility for what happened to the reports, as he had read them, but insisted that they were “caricatures”. That would help to explain why they were not acted on, but it makes the Department of Health’s insistence that it “drew heavily on them” rather odd.
Further indication that the documents were not acted on is the fact that they raise issues almost identical to those highlighted five years later in the Francis report. If Don Berwick’s warnings had been acted on five years ago, there would be no need to ask him to come back now to step in to sort things out and implement his recommendations.
Alan Johnson
I wonder if the hon. Lady is coming to the point that Francis, a QC, in the course of a two-year public inquiry that produced two volumes, looked at all these documents and said that many of the issues within them had obviously been acted on. During a two-year review, Francis drew completely the opposite conclusions to those that the hon. Lady is drawing.
Charlotte Leslie
I find various elements of the Francis report rather strange, not least that the current chief executive, David Nicholson, is minuted as dismissing the activities of Julie Bailey as merely “lobbying” as opposed to expressing widespread concern about patients, and that this minute was dismissed in evidence, with David Nicholson saying that he could not recall ever having said something like that and thought that he could not possibly have done so. The fact that we are asking Don Berwick back five years after he initially gave his recommendations to Labour Members speaks far louder than a few sentences in the Francis inquiry with which people may beg to differ. However, I will not be distracted by the right hon. Gentleman but go back to my speech.
I will now reveal how crucial mortality data, which Harvard university says should have triggered an “aggressive investigation”, was ignored, and, when it became too prevalent to ignore, was, like so many whistleblowers, discredited. David Nicholson said in response to the Health Committee that he did not know that the Dr Foster mortality data existed until he became chief executive of the NHS in 2006. He also said he did not know there was a problem with the mortality rate at Mid Staffs until 2009. Again, that is the Select Committee, so we must take him at his word. It is odd, however, as we know that David Nicholson attended a presentation in Birmingham in 2004 at which the Dr Foster ethics team gave a presentation on the real-time monitoring tools that it was using to show mortality alerts and the hospital standardised mortality rates.
There are also records of Dr Foster telephoning chief executives of health authorities in 2005 to tell them about the mortality alerts. David Nicholson is named on that list of those getting calls, as chief executive of Birmingham and The Black Country strategic health authority. Between 2005 and 2009, there were 8,000 log- ons to the Dr Foster site from members of staff at West Midlands SHA. We even have a press release from Dr Foster from as early as 2005 congratulating Walsall hospital in, yes, West Midlands SHA, for its improvement in relation to this very same mortality data. The Dr Foster data were published in the “Good Hospital Guide” from 2000 onwards and in national newspapers from 2001 onwards. It is therefore incredible that that was not known about by someone such as David Nicholson, or indeed Ministers and others.
By May 2007, however, people were aware of the data. The then chief executive of West Midlands SHA, Cynthia Bower—Birmingham and West Midlands SHAs play a strangely prominent role in this story—received alerts that there were issues with high mortality rates in the health authority. But instead of taking urgent action to find out what was going wrong, she commissioned the university of, yes, Birmingham to write a report to discredit the data, at a cost of £120,000 to the taxpayer. Stunningly, the British Medical Journal—the journal of the union, the British Medical Association—is on record as allowing the author of the Birmingham report to publish his findings in the BMJ four months before official publication to coincide with the publication of the Healthcare Commission report, in order to discredit the data. A fact little publicised by Ministers and chief executives is that the Birmingham report was severely flawed. Harvard later did a study and found that the data were so watertight that on receiving the alerts,
“it would have been completely irresponsible not to aggressively investigate further.”
Yet again, the reaction to bad news was to bury it, or expensively discredit it, rather than act.
This went all the way to Government. I have seen an internal briefing for the right hon. Member for Exeter (Mr Bradshaw), then a Health Minister, in which officials brief him to stress that the mortality data were not known about until 2007. However, in that very same briefing it is revealed that they know this to be untrue, because they make specific reference to the data being published as far back as 2001 in the “Good Hospital Guide”.
This is only a drop in the ocean of a catalogue of attempts to cover up the awful truth. It is utterly wrong that no one should be held to account for such negligence in their duty to protect patients. The “Code of Conduct for NHS Managers” says that managers must
“make the care and safety of patients my first concern and act to protect them from risk”
and
“accept responsibility for my own work and the proper performance of the people I manage”.
If talk of accountability in this Chamber is to have any credibility at all, especially for those individuals who buried loved ones while Government, departmental and NHS individuals buried the truth, actions must have consequences. To scapegoat is not the same as ensuring that those responsible are held to fair account. Those who do not have a voice—the patients and their families—deserve accountability and more than just words.
Don Berwick is right. We must convert our anger over what has happened into action. That is what Julie Bailey did, without whom this debate and a push for a culture change in the NHS would probably not be happening. It is what my right hon. Friend the Secretary of State did this morning in banning gagging orders. Will he confirm whether that measure will be retrospective? I believe that this Government have secured a good base from which to put clinicians—not managers and politicians —at the heart of setting the priorities of our NHS.
Rosie Cooper (West Lancashire) (Lab)
Although I appreciate and endorse everything the hon. Lady has said about accountability and the managerial code of conduct, who does she think should enforce the code and ensure that it is being followed? Beyond the board and the chief executive, how will organisations be policed?
Charlotte Leslie
I believe that Francis is right: a regulatory organisation for managers is needed.
We must be brave. There must be a cultural clean-out and a new start, including a new head of the NHS Commissioning Board, who does not appoint a deputy who faces possible investigation for gagging whistleblowers —unless, of course, Dame Barbara Hakin deregisters from the General Medical Council beforehand—and who does not seem systematically to appoint those who had contact with West Midlands health authority or Birmingham, but has the trust and faith of doctors, nurses and patients, and epitomises this new era of transparency and accountability.
I believe that with Don Berwick’s help—albeit about five years later than it could have happened—we are now beginning to step in the right direction to ensure that never again can the NHS be too loved to be scrutinised or too holy to be questioned, and that this debate will go some way to breaking what has been, for more than a decade, a literally deadly silence.
Dr Lee
Despite that, nothing changed, did it? The CQC has a terrible reputation in my profession, and to have handed the matter over to it—when it was run by someone who was implicated at Mid Staffordshire—is not a defence.
Let me broaden the discussion to something that I may know something about: practising medicine in organisations run by the Department of Health. I can tell the House that the prevailing atmosphere is one in which attention is not drawn to problems. There is a fear for jobs down the line. Let me give an example. When I was a junior doctor, I misused a photocopying machine in a hospital. Within hours, I received a phone call from a middle-grade doctor telling me that if I did that again, it would affect my reference. The phone call, I was told, had been authorised by the then consultant general surgeon at St Mary’s, Ara Darzi. I reflected on that at the time. It made me feel rather intimidated. [Interruption.] The prevailing mood in hospitals was that seeing or doing something wrong could adversely affect a person’s future career.
Charlotte Leslie
Does my hon. Friend share my regret that Opposition Members are groaning in that way? What he is describing has been very evident for very many years. One need only speak to a doctor to learn that there is a culture of fear. Nearly every doctor knows someone who has tried to speak out against something that has happened. People know that if they do that, there will be counter-allegations against them. The groaning and expressions of surprise from Opposition Members are very sad, because it reveals just how little they were actually talking to clinicians on the ground who have been complaining about this for a decade. I received an e-mail from the spouse of a clinician who said that over the past 15 years the management styles encouraged by the previous Government had made that clinician ill.
Alan Johnson
The Secretary of State is right. Of course there need to be safeguards to ensure any system has a backstop to stop people misusing targets. The guidance from the Department of Health was very clear. In no way must the pursuance of targets interfere with the need for good patient care. The Stafford chief executive must have translated that into saying it was fine to put receptionists on triage nursing. With all due respect to the Secretary of State, I do not think that he or any of his successors or predecessors can make regulations to meet every eventuality, including for someone like that chief executive of the Mid Staffs trust.
Charlotte Leslie
In some ways I agree with the right hon. Gentleman, in that I think targets and ensuring that things are happening is not the main cause of what went wrong. Does he agree, however, that targets along with what many medical professionals criticise as the de-professionalising of the work force through the consultant contract, the working time directive and the new deal was a toxic combination?
Alan Johnson
The principal point about targets is that they reduced waiting list times. They changed a situation in which people were dying while on waiting lists, which was a disgrace in a civilised country like ours.
The Francis report also gives no comfort to those who expected him to offer up Sir David Nicholson’s head on a plate. The irony is that they choose to make this attack on an NHS that is learning the lessons of Stafford and an individual, Sir David Nicholson, who has done more than anyone to make quality of care the organising principle of the NHS. I, like my three successors as Health Secretary, consider Sir David to be part of the solution, rather than part of the problem He is not perfect—none of us is—but he is a good public servant who is committed to the NHS, its patients and staff. If he knew what was going on at Stafford, or colluded in the awful events there, or if any of his edicts, policies or pronouncements were in any way responsible for what happened, I would agree with his detractors. No one knew what was going on at Stafford; not even the press, who pride themselves on fearlessly exposing wrongdoing. Not a single question was raised by local MPs in this House about what was happening at Stafford, and Francis has something to say about the way they passed on complaints.
Charlotte Leslie (Bristol North West) (Con)
This has been an excellent debate. I thank the Secretary of State, who has been here for the duration of the debate—as indeed has the shadow Secretary of State. I think there can be general agreement that there has been a catastrophic failure of leadership. That was well and forensically expressed by my hon. Friend the hon. Member for North East Cambridgeshire (Stephen Barclay). It is worth nothing that although there may have been instances—there certainly have been—of clinical failures, it is only possible to hold to account those managers who have a medical qualification registered with the General Medical Council.
We had a blast of reality from the moving and extraordinarily memorable speech by the right hon. Member for Cynon Valley (Ann Clwyd). I thank her, and the people who wrote to her, for sharing their tragic stories. We had powerful and thoughtful speeches from Members involved in the Mid Staffs tragedy, including my hon. Friends the Members for Cannock Chase (Mr Burley), for Stafford (Jeremy Lefroy) and for Stone (Mr Cash). The debate benefited from the experience of Members who have worked directly in the NHS, including my hon. Friends the Members for Totnes (Dr Wollaston) and for Bracknell (Dr Lee), and from the political experience of those such as the right hon. Member for Holborn and St Pancras (Frank Dobson). I thank everybody for their contributions.
This has been an important debate, in that it has finally provided a voice for many people who have been kept silent for so long. Another lesson that we can draw from it is that it is not systems but people who care in our health service. We can take away from the debate the many mechanisms of accountability and transparency that have been suggested, as well as suggestions of how we can nurture the professionalism and the best instincts of those who work in our NHS. Let that be a mission for all of us. We must also really ensure—perhaps in contrast to what has been done before—that patients are at the very heart of what the NHS is all about.
The debate has been enormously important, and I hope that it marks the beginning of a consensus and of a cross-party drive to ensure that the scandals and tragedies that we have seen throughout our health system never occur again. I also hope that this marks the forming of a platform for the many people out there who do not have the benefit of parliamentary privilege. It is our duty to ensure that their silence—in many cases, a deadly silence—is ended by this debate and that a new era of transparency and accountability, which should be seen in by a new set of personnel in our NHS, begins here.
Question put and agreed to.
Resolved,
That this House believes that in the wake of the Francis Report it is clear that accountability and transparency are of paramount importance to patient safety and trust in the NHS; and further believes that across the NHS individuals found to have breached those principles should face the appropriate consequences.
Health Professionals: Regulation
Charlotte Leslie Excerpts(11 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
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.
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.
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.