Managing Risk in the NHS

Debate between Charlotte Leslie and Phillip Lee

Wednesday 17th July 2013 Commons Chamber

[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.

Accountability and Transparency in the NHS

Debate between Charlotte Leslie and Phillip Lee

Thursday 14th March 2013 Commons Chamber

[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.

[Dr Lee]

Of course my hon. Friend is right.