Health: Patient Safety

Earl Howe Excerpts

Tuesday 24th June 2014 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I now repeat a Statement made earlier today in another place by my right honourable friend the Secretary of State on the subject of patient safety.

“Mr Speaker, I would like to make a Statement to the House about a package of measures that I have announced today in order to boost safety, transparency and openness in our NHS following my earlier Written Ministerial Statement.

Just last week, the respected Commonwealth Fund ranked the UK in first place for quality of care, including safety. We compare well internationally and it is clear that we have much to be proud of. However, it is also clear that there is more to do. We must not be complacent.

It is estimated that 12,000 deaths a year in hospitals have a 50% chance of being prevented. Figures released by NHS England today tell us that there were 32 ‘never events’ in the last two months, including a throat pack and a hypodermic needle being left inside patients post-surgery. These are shocking statistics.

In the Government’s response to Sir Robert Francis’s landmark public inquiry on the poor standards of care at Mid Staffordshire NHS Foundation Trust, I made clear our determination to make the NHS the safest and most open and transparent healthcare system in the world.

So, today, all hospital trusts around the country will receive an invitation to ‘Sign up to Safety’. This campaign, led by Sir David Dalton, the inspirational chief executive of Salford Royal, will help us achieve our ambition of halving avoidable harm and thereby potentially save 6,000 lives. Trusts will be asked to devise and deliver a safety plan, and may receive a financial incentive from the NHS Litigation Authority to support implementation.

Mr Speaker, we are also fulfilling the pledge we made in our response to Francis to create a hospital safety website for patients. As of today, the NHS Choices website will tell us how all hospital trusts are performing across a range of seven key safety indicators including ‘open and honest reporting’. And, for the first time, the website will let patients and the public see whether a hospital has achieved its planned levels for nursing hours.

Indeed, I am pleased to inform the House that the latest workforce statistics published today show us that we have 5,900 more nurses on our hospital wards since our response to Francis.

Mr Speaker, I am proud that the NHS is blazing a trail on openness and transparency. We are the first country in the world to publish this breadth and depth of safety data.

Finally, I am pleased to announce today that Sir Robert Francis QC will be chairing an independent review on creating an open and honest reporting culture in the NHS. This review will provide advice and recommendations to ensure that NHS workers can speak up without fear of retribution. The review will also look at how we can ensure that where NHS whistleblowers have been mistreated; there are appropriate remedies for staff and accountability for those mistreating them.

Mr Speaker, I am confident that this package of measures will shine a light on poor care so that lessons can be learnt, action can be taken and harm to patients prevented”.

That concludes the Statement.

--- Later in debate ---

[Earl Howe]

My Lords, I am grateful to the noble Lord for his welcome of the measures that we have announced today. They must be seen in the context of other measures that we have taken in the light of Robert Francis’s report, many of which have been debated in this House.

The noble Lord spoke about a culture of naming, shaming and blaming. I do not see it in that light. The key message from Robert Francis was surely that we need a change of culture in many of our NHS institutions. That is not something that can be dictated by legislation. On the other hand, it is something that we can assist in promoting by means of transparency. The whole drive towards quality is surely assisted by shining a light on poor practice where it exists, encouraging all staff in hospitals to take ownership of what their organisation is doing and then putting those things right. That culture should extend from the board right down to the lowest level of staff. This is part and parcel of the move that the NHS is trying to make in the direction of creating a better culture—one that exists in many parts of our NHS but not in enough of them.

Do we intend to promote transparency in all those providing services to the NHS? Yes, that is the intention. This would be done by means of the NHS standard contract, which in time will incorporate the necessary provisions.

As regards infection rates in hospitals, the picture nationally is in fact very good. The numbers of MRSA bloodstream and C. diff infections are currently at record lows, but there is no scope for complacency. We believe that the website that I referred to in the answer that I repeated, which will incorporate the indicator relating to infection and cleanliness, will act as a spur to hospitals when they know that their patients can see the degree of infection pertaining over the previous three-month period.

How do we intend to save the lives that we have the ambition to save? As I said at the beginning, much of this depends on openness, on transparency and clarity for the public, and indeed on staff taking ownership of problems where they exist, not shying away from them. We think of measures like the fundamental standards being introduced that will define the level below which standards of care should never fall. We think of the duty of candour that is to be introduced. We think of the new ways in which the Care Quality Commission, with its new chief inspectors, is approaching the task of assessing the quality and safety of institutions. All these things combined should be seen as part and parcel of the picture.

[Baroness Brinton (LD)]

My Lords, a 2012 report by the American Department of Health showed that 86% of reportable events were not reported, partly because of staff misperceptions about what constitutes patient harm. Will the Minister reassure the House that both the Government and the NHS regard one in five incidents going unreported as unacceptable? What will the Government do to ensure that all staff understand what needs to be reported and do so in a truly open and transparent culture?

[Earl Howe]

My noble friend makes a series of very important points. Clearly, a balance has to be struck here. It would become self-defeating if every single mistake, even one that had no bearing on patient safety, had to be reported by every single member of staff. The system would be overloaded. We are keen to ensure that those incidents that result in potential harm, real harm or—worse still—death are reported, exposed and dealt with. Of course the National Reporting and Learning System, which was originally part of the National Patient Safety Agency when the previous Government set it up and is now housed at Imperial College Healthcare NHS Trust, has the task of collating safety incidents from trusts and drawing lessons from them. That is every bit as important a process as it ever was. It will be the task of NHS England to draw those lessons together and incorporate them in its commissioning guidance. My noble friend has raised that issue and we have a task ahead of us that will take some time to achieve; but I believe that this is a welcome start.

[Lord Pearson of Rannoch (UKIP)]

My Lords, looking back on it, was the Nursing 2000 initiative not a bad mistake because it turned nursing into an all-graduate profession, with degrees supplied by the second-rate social science departments of the former polytechnics? Are the Government doing anything with the training of nurses that reflects what the noble Lord’s colleague at education, Mr Gove, is doing with the training of teachers, about which we heard in the first Question today? Is there a new emphasis on practical training and on getting back to matron and the discipline of the ward?

[Earl Howe]

It was only recently that the Nursing and Midwifery Council revised the curriculum for the training of nurses. I am sure that the noble Lord will be pleased to know that that curriculum is broadly divided 50:50 into practical training and training in the classroom, which was the balance historically. I believe that nurse training is now set fair for the future. The noble Lord is right to raise concerns about Project 2000, which many people felt did not quite address the needs of nurse training. However, that programme is substantially different now from what it was in 2000.

[Lord Willis of Knaresborough (LD)]

My Lords, I am delighted to follow the arch-moderniser, the noble Lord, Lord Pearson. In the whole of my noble friend’s Statement, and indeed until the noble Lord raised his question, not a word was mentioned about the training of the staff who actually care for our patients. We have a situation in which, unless you are a medic, you are not entitled, even if you are a qualified nurse, to have resources spent on you in order to continually update your professional development. In terms of preceptorship, there are no resources; in terms of mentorship, there are little additional resources; and there is virtually no resource to train healthcare assistants. Will my noble friend agree that although the move to have 9,000 more nurses is incredibly welcome, we need to put training at the very heart of the safety agenda, because unless we train we will not get high-quality staff?

[Earl Howe]

I agree with my noble friend; it would be difficult to disagree with him. Training is essential if we are to have high-quality staff. That is why we have protected the training budget, which is now hosted by Health Education England, whose job it is to ensure not just that there are adequate numbers of each type of professional in the health service but that the quality of the training is as we would all wish. It is the task of the local education and training boards to assess the position at a local level and, informed by the NHS providers that are under their wing, to respond to the needs of those providers.