NHS: Learning from Mistakes

Baroness Laing of Elderslie Excerpts

Wednesday 9th March 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I thank the Secretary of State for his statement. The Opposition support any measures that will improve safety in our NHS and make it more open to learning from mistakes. However, we will also provide robust opposition and scrutiny when we think that the Secretary of State’s actions are having the reverse effect.

Let me start by setting out where we support the Government. On the independent medical examiners, the Secretary of State will know that that is a reform that the Opposition have long pushed for. The previous Labour Government legislated in 2009 for the introduction of medical examiners, following the inquiry into the crimes of Harold Shipman. The call to introduce medical examiners was then repeated in the Francis report and in the report of the Morecambe Bay investigation, chaired by Dr Bill Kirkup. Indeed, last year’s Kirkup report said:

“We cannot understand why this has not already been implemented in full”.

We welcome the implementation of the medical examiners system, but it is concerning that it appears to have been delayed until April 2018. Will the Secretary of State say why progress in that area is so slow? Will he reconsider the timetable for their introduction given that April 2018 is more than two years away? Will he say more about how the reform will be funded? Local government faces further cuts over the coming years and while I understand that local authorities will be reimbursed for set-up costs, they will have to collect fees to fund the service. How will that work in practice? Is the Secretary of State confident that local government, which is already having to do more for less, will be able to take on the role of administering this process?

We also support the changes to the GMC and NMC guidance that the Health Secretary is announcing today, which will recognise the importance of an apology, but it is unclear how that is different from the guidance that came into effect last August. Indeed, the GMC first announced plans to change its guidance in this way more than a year ago, so can he say how his announcement today differs from the plans that were already in place?

On the learning from mistakes league, how will the 32 trusts that have a poor reporting culture be supported to improve? We know from listening to the testimonies of Sara Ryan, the mother of Connor Sparrowhawk, that the learning culture in some trusts just is not good enough. I know, from speaking to the small number of my constituents who have experienced failures of care, that the fight to get mistakes recognised is only part of the battle. They also want to know that the failures they have experienced will never happen to anyone else, yet all too often they are faced with a system that seems as though it simply struggles to learn.

Does the Secretary of State accept that he needs to do much more to develop a positive learning culture in our NHS? How in practical terms will he support clinicians and managers to improve services? Go to any health trust and we will find a director of finance and non-executive directors with financial expertise, but rarely will we see the same attention being paid to quality. Does the Health Secretary not agree that every trust board needs someone whose focus is not short-term firefighting, but co-ordinating and bringing together staff to drive improvements in quality?

I will always support sensible steps to improve safety and transparency in the delivery of health services, but what I cannot do is stand here today and pretend that other actions taken by this Government will not have a detrimental effect on patient care. The Health Secretary’s kamikaze approach to the junior doctor contract means that no matter how the dispute ends, he will have lost the good will of staff, on which the NHS survives. How can he stand here and talk about patient safety when it is him and him alone who is to blame for the current industrial action, for the destruction of staff morale and for the potential exodus of junior doctors to the southern hemisphere? [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order.

[Heidi Alexander]

Thank you, Madam Deputy Speaker. I ask the Health Secretary: how can he stand here and say that he wants the NHS to deliver the highest-quality care in the world when the people he depends upon to deliver that care for patients have said, “Enough is enough”? How can he talk about patient safety when he knows that his £22 billion-worth of so-called “efficiency savings” in the next four years will lead to job cuts and will heap more pressure upon a service that is about to break?

I know the Health Secretary has been shy about visiting the NHS front line in the past few months, but if we speak to anyone who has any contact with the NHS, the message we will hear is clear: the financial crisis facing the NHS is putting patient care at risk. The independent King’s Fund recently said:

“Three years on from Robert Francis’s report into Mid Staffs, which emphasises that safe staffing was the key to maintaining quality of care, the financial meltdown in the NHS now means that the policy is being abandoned”.

That is simply not good enough. For those people who have experienced failures of care and for those staff working in environments so pressurised that they fear for the quality of care they are able to deliver, the Health Secretary needs to get his head out of the sand. I say this to him: measures to investigate and identify harm are all well and good but there needs to be action to prevent harm from happening in the first place—fund the NHS adequately, staff it properly and you might just give it a fighting chance.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before the Secretary of State answers that important question, I remind the House that we have a lot of business to get through today. Shorter questions and correspondingly shorter answers would be welcomed by those who are waiting to take part in other debates.

[Mr Hunt]

As ever, I commend the right hon Gentleman’s interest in mental health. May I reassure him that this is very much about what happens in mental health and also the area of learning disabilities? In fact, some of the thoughts were prompted by what happened at Southern Health. It is absolutely vital that we investigate unexpected deaths in mental health as much as we do in physical health. The measures we take will go across those areas, and I am more than happy to meet him to discuss the very laudable aim of zero suicides.

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[Maria Caulfield (Lewes) (Con)]

I congratulate the Secretary of State on his statement this afternoon, and welcome the culture change that he is introducing to the NHS. My experience of working in the NHS under a number of Governments over the past 20 years was that when mistakes happened, a scapegoat was identified and it was thought that the problem had been dealt with. That is why people were reluctant to report problems, but often it is not one individual but a system of failure. We need to learn from that, so I welcome the Secretary of State’s comments. Relatives and patients have said to me that they do not want just to identify the problem; they want to ensure that it never happens again, which is exactly what my right hon. Friend said. I chaired a primary care seminar this morning with GPs, doctors, nurses and pharmacists—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am sure that the hon. Lady will quickly come to her question, or we will run out of time.

[Maria Caulfield]

Thank you, Madam Deputy Speaker. People are fed up with the NHS being talked down by Labour Members, and there was a plea to showcase the good work that is taking place in our NHS today.

[Paula Sherriff (Dewsbury) (Lab)]

Last week I received an email that was frankly heartbreaking. My constituent’s 84-year-old father, a proud and dignified man, was admitted to hospital with symptoms of a stroke, and he had to wait 14 hours for a bed. She went to visit him later that day and found him in bed wearing clothes on only his top half. He needed the toilet, and she was given a bottle to help him urinate.

[Madam Deputy Speaker]

Order. I am sure that the hon. Lady will quickly come to her question.

[Paula Sherriff]

That was no dignified way to treat that man. Will the Secretary of State agree to an urgent investigation into safe staffing levels at Mid Yorkshire Hospitals NHS Trust, because the nursing staff told my constituent that they did not have time to fulfil her father’s basic nursing needs?

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[Mr Hunt]

My hon. Friend is absolutely right. I thank him for his work in this area. Maternity—stillbirths, neonatal deaths, neonatal injuries and maternal deaths—is the area where I hope we make the most rapid early progress in developing this new learning culture. There is so much to be gained. We can be the best in the world, but the truth is that we are a long way down international league tables in this area. None of us want that for the NHS. There is a real commitment to turn that around and I thank him for his support.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The prize for perseverance and patience goes to Mr Mark Spencer.

[Mark Spencer (Sherwood) (Con)]

I am grateful, Madam Deputy Speaker, even if my knees are not.

I congratulate the Secretary of State on providing a protected space for doctors, so they will be able to be honest and upfront when things go wrong, and on striking the right balance so that relatives and people who suffer wrongs in the NHS get to the bottom of what went wrong, why it went wrong and why it will not happen again.