Mid Staffordshire NHS Foundation Trust (Inquiry)

Edward Miliband Excerpts

Wednesday 6th February 2013 Commons Chamber

[Edward Miliband (Doncaster North) (Lab)]

I thank the Prime Minister for his statement and for the tone in which he made it. The NHS represents the best values of this country, and what happened at Stafford was an appalling betrayal of those values. We all think that when our own loved ones—our mother or father, grandmother or grandfather—go into hospital, we are placing them in the trust of the NHS and we expect hospitals to be places of utmost compassion and the highest standards of care. At Stafford, patients became victims and their relatives who pleaded for assistance were ignored or even made to feel intimidated.

Let me join the Prime Minister in paying tribute to all those former patients, relatives and staff who came forward to speak out, including those who gave evidence to this and to previous inquiries. Let me also thank Robert Francis for his work on this and on the previous inquiry.

Let me also say, as was reflected in the Prime Minister’s remarks, that what happened at Stafford was not typical of the NHS. Day in, day out, the vast majority of those who go to work in our NHS deliver great care to patients up and down the country. They are as horrified as all of us by what happened in Stafford.

The previous Government were right to apologise on behalf of the Government and the NHS to the patients and families that suffered so badly at Stafford hospital. I reaffirm that today. We on the Labour side are truly sorry for what happened. What happened has no place in any NHS hospital. We must ensure that it does not and cannot happen again.

As the Prime Minister makes clear, today’s report says that the primary responsibility for what happened lay with the board of the hospital, but there are wider lessons that politicians on all sides must learn, including a lesson for all parties about the dangers of frequent reorganisations of the NHS, which Francis mentions.

The Prime Minister says it will take some time to digest the report in full, so let me ask some specific questions. First, on the patient voice, effective regulation is essential, but the reality is that regulators cannot be everywhere spotting every problem. Patients, their families and staff are everywhere in our NHS, so we must ensure that they are properly heard.

The challenge is to change the culture of the NHS and to support rather than shut out people who complain. The NHS constitution offers protections for whistleblowers, and we support moves to strengthen that. The Francis report, however, also highlights criticisms and concerns about both previous and current arrangements for patient bodies. Does the Prime Minister agree—from something he said earlier, I think he does—that whatever bodies we choose to represent patients, they need to be independent and have the powers to be an effective voice and challenge to the system.

Secondly, on staffing, the basic requirements of any NHS hospital are that there are sufficient staff to look after patients and that they act with compassion. In too many cases at Stafford, that just did not happen. Compassion should always be at the heart of nursing, and it needs to be at the heart of nurse training, so we support the moves that the Prime Minister announced.

As Robert Francis has said previously—I quote from the first report—in explaining what went wrong:

“the overwhelmingly prevalent factors were a lack of staff, both in terms of absolute numbers and appropriate skills”.

Does the Prime Minister accept the report’s point that we need to consider benchmarks on staff numbers and skills throughout our NHS?

Thirdly, on regulation, the problems at Stafford should have been picked up much earlier. Monitor and the Healthcare Commission should have worked together much more closely. We will look at the Prime Minister’s proposals around the chief inspector of nursing care, but does he support the move to a single regulator, which is in the Francis report? On health care assistants—the Prime Minister mentioned them—who do such important work in our hospital wards and communities, does he agree that we need training and registration for them to improve standards and safety?

Fourthly, on foundation trust status, the enthusiasm for foundation trusts has been shared on both sides of this House, and the journey to foundation trust status has clearly been a beneficial process for many trusts. In the case of Stafford, however, it clearly was not. For the future, has the Prime Minister made any reassessment of the current timetable for other trusts to achieve foundation status and of whether more flexibility is needed?

Fifthly, on waiting time targets, today’s report clearly states that

“it is not suggested that properly designed targets, appropriately monitored, cannot provide considerable benefit to patients”.

In other words, targets have their place, but they must be kept in their place. Does the Prime Minister accept that, as the Francis analysis suggests, the problem at Stafford was how the A and E target was managed by that hospital, and that many hospitals up and down the country have delivered excellent care while meeting the A and E target? Neither he nor I want to go back to the days when people were left waiting 12 hours on trolleys and 18 months for an operation.

Finally, let me turn to the issue of integration. I believe that there is a bigger overarching issue here, which applies not just in Stafford, but elsewhere in our NHS. It is something that my right hon. Friend the shadow Health Secretary has talked about recently. The ageing society is bringing a whole new set of demands on the NHS. A group of elderly and infirm patients require not just physical treatment for their immediate illness, but need much greater care and attention for their basic needs. As the Francis report says, we must address this new challenge that the NHS faces to make sure we avoid a repeat of what happened at Stafford.

Does the Prime Minister agree that in every hospital we need to put in place the right support for the whole of a person’s needs, including those of the elderly population? Does he further agree that that means breaking down the barriers that still exist in much of the country between health care provided by the NHS and social care provided by local authorities?

We cannot turn the clock back and undo the damage that happened at Stafford, but we owe it to those who suffered, to the people of Stafford and to the country as a whole to work together to act on this report and to prevent a scandal like this from happening elsewhere. We in the Opposition will play our part in making that happen.

[The Prime Minister]

I thank the right hon. Gentleman for his remarks and for the tone in which he made them. I apologise for not getting my response to the report to him a little earlier this morning. That was a technical mistake rather than anything more sinister. The right hon. Gentleman is right to thank the relatives and to thank Robert Francis for his work. Let me try to answer the right hon. Gentleman’s questions.

On the issue of reorganisations, Francis says:

“The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require root and branch reorganisation—the system has had many of those—but it requires changes which can largely be implemented within the system that has now been created by the new reforms.”

I hope we can agree that the best thing to do now is to learn the lessons and put in place what needs to be done.

The right hon. Gentleman is absolutely right to raise the issue of listening to patients. As he said, we have got to make sure that whatever organisation we have—we have established HealthWatch—is independent, credible and has power. It is interesting to note what Francis finds on page 46:

“It is now quite clear that what replaced”

community health councils, and there were

“two attempts at reorganisation in 10 years, failed to produce an improved voice for patients and the public, but achieved the opposite.”

We need to learn the lessons and try to make sure that HealthWatch becomes everything we all want it to be.

As for supporting complaints, what Francis and the right hon. Gentleman said is that when there are complaints, they have got to be given a bigger voice and be taken seriously. Here, Members of Parliament have a role to play. Somewhere, buried in the report, there is a passage that is mildly critical of MPs. Like others in the community, we love our local hospitals and we always want to stand up for them, but we have to be careful to look at the results in our local hospitals and work out whether we should not sometimes give voice to some of the concerns rather than go along with a culture that says everything is all right all of the time—sometimes it is not.

On the issue of staff numbers and benchmarks, we think it important that there should be some benchmarks. We believe that because of the funding commitment we have made, there is no excuse for understaffing or for staff shortages, but that obviously requires good management.

On having a single regulator, the right hon. Gentleman made a lot of points about Monitor and the Care Quality Commission and whether there was confusion between them. When he talks of strengthening the CQC and giving it greater powers, that is in principle, as I said in my statement, the right direction to go in.

The right hon. Gentleman asked about trusts, and both sides of the House have supported the idea of foundation trusts, making sure hospitals are more accountable, more responsible and able to take more decisions. The problem is not with creating foundation trusts, but arises if the move to create them means that other things that matter more than trust status—such as patient care—are pushed to one side. We must all learn the lesson and ensure that for the next round of trust creation, they must not be rushed and they must happen only when they are ready and on the basis that patient care comes first.

The point about targets is important. I believe that there is a place for targets in our NHS, but I think that under the last Government they became too tight and too obsessive. I also think that the last Government recognised that themselves, and started to change the approach.

The public have a right to know that waiting times in A and E will not be too long and that treatments will be carried out quickly, so there is an importance in targets. I think that what Francis is saying is that it was not the targets that were to blame, but a culture in the hospital—and perhaps in other hospitals, although he does not inquire into that—in which targets and their achievement were placed ahead of patient care. Again, the two should not be alternatives.

What the right hon. Gentleman said about the ageing population and the challenge facing our NHS was absolutely right. A key part of our dementia challenge is raising the standard of, in particular, the way in which we treat elderly people in our hospitals. I also agree with the right hon. Gentleman that we need to break down the barrier between health and social care.

I hope that the report will provide not an opportunity to try to find scapegoats or to fire up some phony political debate, but a moment when everyone in the House can agree. We all love our national health service, and this afternoon’s discussion shows that we have the same ideas about patient care, about quality, about bringing health and social care together, and about ensuring that a good, rational system has patients at its heart. I hope that this can be a moment when the country comes together over our NHS, rather than seeking divisions.