Managing Risk in the NHS

Derek Twigg Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

We have just heard it; this is what the NHS has been reduced to. The Minister has to make representations to NHS England about cancer services of all things. My goodness, if Ministers are not responsible for cancer services, what are they responsible for? Who is making the decisions and who is responsible for what? Even now, confusion reigns.

What precisely is the role of the Secretary of State in this new world? He has cast himself in a new role as a detached commentator on the sidelines, magnifying all of the NHS’s failings and accepting none of the responsibility to fix them. I assume that that is all for NHS England, too. With the NHS already laid low by cuts and reorganisation, the Secretary of State has opened up a new front on staff: nurses repeatedly blamed for not caring enough; hospitals blamed for coasting, as I have said; GPs blamed for causing the A and E crisis. Everything is someone else’s fault.

Then we get to this weekend. The Keogh report rightly exposed poor care standards, which should never be tolerated; we support action to tackle to them. The report, however, exposed something else, too—a Government who are now actively spinning against the NHS for which they are responsible, generating misleading or, in Sir Bruce’s words, “reckless” headlines about 14 already troubled hospitals. What chance do they have of improving when the man supposedly in charge is actively doing them down?

[Derek Twigg (Halton) (Lab)]

My right hon. Friend mentions the Keogh report and we are talking about the present day. Keogh says in the report that he found

“frequent examples of inadequate numbers of nursing staff in some ward areas…The reported data did not provide a true picture of the numbers of staff actually working on the wards.”

There we have it: it is this Government who are not making sure that our hospitals are properly staffed.

[Andy Burnham]

I am grateful to my hon. Friend and I will come to that precise point, as one would think that that was a responsibility of a Secretary of State. Who knows, though, what their responsibilities are now. Presumably that is a matter for NHS England as well. We shall return to the point in a few moments.

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[Mr Hunt]

It is funny how the Labour party decided to make the NHS its main campaigning issue for the past three years, yet the moment people start to scrutinise its own record on the NHS it says the NHS is being used as a political football. What does that say about Labour’s approach to the NHS?

I want to consider the specifics of the motion before looking at the wider issue of risk. The motion mentions the Francis inquiry. One of this Government’s first acts on coming to power was to set up the full public inquiry into Mid Staffs that families had been denied by the right hon. Gentleman’s Government for too long. We are implementing it, and fast. That is why a new chief inspector of hospitals started work yesterday, just five months after the report was published. [Interruption.] The right hon. Gentleman says that a chief inspector of hospitals is not in the report, but how are we going to make sure that the report’s recommendations are implemented throughout all 266 NHS trusts? That will be done because we will have independent inspection of hospitals, which has not been done before because the situation was so undermined by the previous Government. That is how we are going to make sure that Francis actually happens.

We intend to implement the spirit of everything that Robert Francis proposed, even if the details may vary in places from his 290 recommendations. Francis himself endorsed that approach when that he said that the Government have indicated their

“determination to make positive changes to the culture of the NHS, in part by adopting some of my recommendations and in part through other initiatives.”

Francis talked about five themes, so let us look at the progress being made on them. First, on information and transparency, yesterday showed that this Government are determined to root out, once and for all, an NHS culture of solving problems behind closed doors. This is about not just the decision to hold a public inquiry into Mid Staffs, which the right hon. Member for Leigh and his colleagues rejected doing 81 times, but the Keogh review, which reported yesterday that 14 hospital trusts have excess mortality rates. This is the first time the NHS has ever conducted such a review. We have also published individual surgeon outcomes—the first country in the world to do so across an entire health system. The independent rating of hospitals will start this autumn, so for the first time people will know how good their local hospital is, just as they do for their local school.

Francis also mentioned standards. The new chief inspector of hospitals—a position that Labour still refuses to support—began work yesterday. In Professor Sir Mike Richards, we have a new whistleblower-in-chief whose sole job is to drive up standards and root out poor care. He will be supported by a team of expert inspectors, in stark contrast to the generalist inspection model set out by the right hon. Gentleman’s Government in 2009. That is plain common sense. We have put it right. The work of the inspectors will be informed by the independent review of hospital safety that is being conducted by Professor Don Berwick, who will advise on how to embed a culture of patient safety throughout the NHS. He will report back later this summer.

[Derek Twigg]

Yesterday, when I asked the Secretary of State whether mortality had fallen before 2010, his answer was:

“According to Professor Jarman…it has been falling slightly.”—[Official Report, 16 July 2013; Vol. 566, c. 944.]

The Keogh report states that it had fallen by 30% over 10 years. Figures from the House of Commons Library, which were sourced from the NHS, show that there has been a significant fall in deaths within 30 days of non-elective hospital procedures. Will he correct the record?

[Mr Hunt]

I am afraid that that intervention sums up where the spin is happening. The 14 hospitals were investigated by Professor Keogh because they had excess mortality rates. The Labour party thinks that that started in 2010, but it goes right back to 2005 in those hospitals and earlier than that in many of them. That is the ugly truth that Labour refuses to confront: 14 hospitals had high mortality rates for years and years, and Labour did nothing to sort it out.

The Francis report—

[Derek Twigg]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress. The Francis report also talked about leadership.

--- Later in debate ---

[Derek Twigg (Halton) (Lab)]

No one would disagree that if there are problems with standards or care in any hospital or any part of the health service every effort should be made to bear down on those problems and deal with them, whether that is by supporting the leaders or clinicians who are responsible for it, or removing them, if necessary. We must bear down on problems and continue to improve standards. Everybody wants to see that. When we are trying to build on the improvements of the Labour Government, it does not help to undertake at the same time a reckless reorganisation of the NHS, which has taken a massive amount of time and effort, cost at least £3 billion and opened the door to privatisation. That has caused chaos in the health service.

I talk to staff and managers regularly. There is massive pressure on them. They feel completely uncared for. They feel that no one is bothered. They are told to do things for which they do not have staffing. They have to maintain standards, which is very difficult because of shortages of staff and because of the pressures on them.

[Mr Andrew Smith]

Among the many other dangers of privatisation, is not one particularly relevant to the debate today the fact that transparency will be lost because of private commercial organisations’ unwillingness to share information and be transparent?

[Derek Twigg]

My right hon. Friend makes an important point. That is one of the things that we explored during the Committee stage of the Health and Social Care Bill and of course we got no answers. The then Minister, now Minister of State, Department for Transport, the right hon. Member for Chelmsford (Mr Burns), said that as time goes on the NHS will be more open to the competition laws of both the EU and the UK. That is the real story here, and we will not have that transparency. That is a major part of the problem we are having to deal with.

No matter what statistics we are talking about, losing a friend or loved one is a massive human tragedy that affects everybody. We want to do all we can to reduce the number of early and preventable deaths—that is absolutely right—and put patients’ interests and those of families first. Given what we have heard in the last day or so, one would think that we somehow left an NHS in crisis—an NHS that was not delivering—yet when we left office it had the highest satisfaction rate in history. We had the lowest waiting lists in history and massive reductions in early deaths from cancer, coronary problems and so on. We also saw massive increases in doctors and nurses. We hear this Government talking about increasing the number of doctors, but when did those doctors start their training? They started under Labour.

To give an example, so that we can be a bit fairer about the situation, the Commonwealth Fund produced an international health policy survey in 2010 that looked at 11 countries—and guess what? The UK health service came out best. Just as an example, when those on above average incomes and those on below average incomes were asked whether they were confident that they would receive the most effective treatment if sick, the best results—95% and 92%—were in the UK. That was an international survey. Another question was whether people were confident that they would receive the most effective treatment if sick—and guess what again? The UK came out on top, at 92%. That is the real picture of the NHS that we left behind in 2010—although it was not without its problems and challenges, because pressures were always building up.

I also noticed that pages 4 to 5 of the Keogh report say—this is an important comment that has not been looked at much in the press—the following:

“Between 2000 and 2008, the NHS was rightly focused on rebuilding capacity and improving access after decades of neglect. The key issue was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

That is where Labour made one of the biggest differences. I remember regularly having people write to me back in the late 1990s and the early 2000s about having to wait over two years for an operation. People were literally dying because of that. Addressing that was one of the biggest gains that Labour made.

The Secretary of State has now left the Chamber, but earlier I raised with him the issue of mortality. He refused to correct the record. He said that there had been a “slight” improvement by 2010, yet Professor Keogh talks about a 30% improvement in mortality in all hospitals, including those that have been under investigation. That is not to say that those hospitals should not be doing better, but he was talking about all hospitals.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Professor Keogh’s report also shows that although mortality has dropped by 30% in all hospitals, it has dropped by between 30% and 50% in the 14 hospitals subject to the Keogh review. Although those hospitals are still outliers, the drop has been greater at those 14 hospitals.

[Derek Twigg]

My hon. Friend makes a strong and important point. I referred earlier to figures from the Library, but those figures are from the NHS. Just to repeat, the rate of deaths per 100,000 within 30 days of a non-elective hospital procedure in England was 4,850 in 2001-02 and 3,684 in 2010-11. That is a significant drop, so I hope the Secretary of State will correct the record, change his view that there was a “slight” improvement and confirm that it was a significant improvement, because that is what the evidence from his own Department says. Why is that important? It is important for a number of reasons. It is important to see improvements, but we should also bear in mind that the fall from 2001 took place against a massive increase—4 million additional admissions—in the number of people admitted to hospital. It is also important because people want to see continual improvements and be assured that their relatives and friends are receiving the best possible treatment.

In the short time I have available, I want to talk about a couple of local issues. Staffing plays a fundamental part in regard to risk. Many hospitals are having real difficulty with staffing at the moment, and many more will do so. I will say more about that in the context of my own hospital in a second. We need to address the problem, and the mix of staff is also a factor.

The Warrington and Halton Hospitals NHS Foundation Trust serves my constituency. We have been told by the chief executive and the chair of the board of governors that our hospital will run out of money in about 18 months’ time. It has already had to make savings in staff numbers of about 200, and implement a £7 million cut. The hospital will be unsustainable in that situation. What are the Government going to do about that? It is a foundation trust, and as far as I am aware, there are no significant performance issues. I get complaints about the different hospitals, but it is no worse than any of the others. It will run out of money, however.

My hon. Friend the Member for St Helens North (Mr Watts) has mentioned the St Helens and Knowsley NHS Trust. The Whiston hospital was rebuilt under Labour’s plan to rebuild hospitals. We replaced Victorian hospitals—and workhouses, as in the case of the Whiston—with more than 100 new hospitals. The deal on the Whiston hospital under Labour involved a private finance initiative, with the difference being paid for by the two primary care trusts. This Government have got rid of the PCTs, but they have still not put in place a way of funding the hospital on a long-term basis. The uncertainty continues, despite debates on the matter in this place and meetings with Ministers, and we still do not know what is going to happen. It is an excellent hospital with brand-new facilities, but it is facing a real challenge. We need the Government to make decisions about hospital funding, to ensure that it and others can continue; otherwise, many more hospitals will get into difficulty.