Managing Risk in the NHS

Dan Poulter Excerpts

Wednesday 17th July 2013 Commons Chamber

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

It is a great pleasure to rise to speak in support of the amendment tabled by my right hon. Friend the Prime Minister.

Both sides of the House believe in our NHS, the staff who work in it and the care they provide for patients. I am also sure that both sides recognise that, in the wake of the Francis inquiry and yesterday’s report from Sir Bruce Keogh, the 65th year of the NHS has been its most challenging and that we need to face up to those challenges.

This debate has had three key themes: the importance of the NHS, the staff who work in it and the care they provide for patients; the importance of making greater productivity gains in the NHS to improve care and make sure that we do more with our resources; and the importance of openness and transparency and the need to learn lessons from things that have gone wrong, so that patient care can be improved.

Back Benchers have made some high-quality contributions. It is always a pleasure to hear the hon. Member for Walsall South (Valerie Vaz) and the right hon. Member for Holborn and St Pancras (Frank Dobson). The hon. Member for Halton (Derek Twigg) made a very strong case for his local health care services. I pay particular tribute to the right hon. Member for Cynon Valley (Ann Clwyd), who has done some tremendous work in looking at how we can improve the NHS complaints procedure. She read out a number of examples of things that have gone badly wrong, from which we need to learn lessons for the future. The work she is doing at the moment is hugely important and valuable, and the Government look forward to receiving her report shortly.

My hon. Friend the Member for Bracknell (Dr Lee) highlighted some of the challenges with the existing NHS estate and the need to modernise facilities and make some of the older buildings more fit for purpose to meet the needs of patients in the modern world. My hon. Friend the Member for Bristol North West (Charlotte Leslie) made a very brave speech. She spoke at great length—and rightly so—about the importance of involving the medical royal colleges in deciding how hospital inspection processes should be implemented and about the importance of clinical leadership and involvement in those inspections to help understand what good care looks like. After all, those colleges are centres of excellence in their fields and it is right that we listen to what they have to say.

My hon. Friend the Member for Southport (John Pugh) made a particularly thoughtful speech. He called for good management and spoke of the need for good managers in the NHS. He also made the important point that, in all our debates on patients who have been let down, the regulators have often not played their part. That is why we need to ensure that the regulators continue to come to the table and that the improvements at the CQC continue. The regulators need to remain fit for purpose.

The problem with mandatory staffing ratios is that they would just provide another tick box that would not necessarily bear a relation to what good clinical care looks like. There is a clear difference between mandatory staffing ratios and appropriate staffing levels, as the Francis report indicated. We need staffing levels that reflect the needs of the patients on the ward. Those will vary from ward to ward and will change on a daily basis according to the needs of different patients. It is important that we consider the patients who are in front of the doctors and nurses on the day. It may not be nursing care that is needed, but care from other members of the multi-disciplinary team such as physiotherapists and health care assistants. That is why it is wrong to use mandatory staffing ratios as a measure of good care.

[Barbara Keeley]

The point that I keep raising with the hon. Gentleman, other Ministers and the Secretary of State is that there must be transparency in the numbers. Ratios of 2:29 have been reported to me, which nobody would be comfortable with. My excellent local hospital puts information about staffing ratios on the boards in each ward. Does he not think that we should move rapidly to provide transparency on this matter? I am asking not for mandated ratios, but transparency so that patients and their families can see what the ratio is.

[Dr Poulter]

The hon. Lady makes a very good point about the importance of having staffing levels that are appropriate to the needs of the patients. That is why NHS England is considering toolkits that will help hospitals to build the right care in the right place and at the right time for patients and to adapt care so that it is provided by the appropriate professionals, according to patient need.

The debate has rightly focused on transparency and openness. We have not got that right in the NHS since the Bristol heart inquiry, which took place under the previous Government. Both the Government and the Opposition believe that we need to support staff who feel that they need to speak out and that there needs to be greater transparency and openness. I believe that the steps that the Government are taking will make a difference. We are introducing a contractual right for staff to raise concerns and issuing guidance on good practice in supporting staff to raise concerns. We are strengthening the NHS constitution and have set up the whistleblowing hotline to support whistleblowers. We are also amending legislation to secure protection for all staff through the Public Interest Disclosure Act 1998. We are doing good work and it is right that we continue to do all that we can to support staff in raising concerns about patient care, where that is appropriate.

We must focus on improving productivity in the NHS so that we can do more with the resources that we have. As the Secretary of State outlined, that is about improving the technology in the NHS so that we can spend more money on care and free up staff time. If we use technology to better join up health and social care, staff will spend less time on paperwork and more time with patients, which will improve patient care.

It is important to consider the fact that there are higher levels of morbidity and mortality at weekends and in the evenings. There needs to be more consultant cover and out-of-hours cover at those crucial times to ensure that the service is more responsive to patients. The Government are addressing that.

In conclusion, at the beginning of this debate, the right hon. Member for Leigh (Andy Burnham) rightly highlighted the long-standing problems in our NHS. Although Labour is now talking about social care, it was the last Labour Government who cut the social care budget between 2005 and 2010. Although Labour is now talking about the risk register, the last Labour Government refused to publish it.

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put accordingly (Standing Order No. 31(2)), That the original words stand part of the Question.