Stafford Hospital

Debate between George Freeman and Jeremy Lefroy

Friday 7th November 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is an absolute pleasure to be back at the Dispatch Box this afternoon. It is a tribute to the tireless commitment of my hon. Friend the Member for Stafford (Jeremy Lefroy) that, not content with successfully piloting the Health and Social Care (Safety and Quality) Bill through its Second Reading this morning, he has called me back this afternoon for a debate on services at Stafford hospital. I think I speak for the whole House, including Members not present today, when I pay tribute to his tireless commitment, both to his constituency and to the local NHS in his area. The way in which he has gone about it has commanded respect across the House.

My hon. Friend raised many important points, as did my hon. Friend the Member for Cannock Chase (Mr Burley), in support of new investment, importantly paying tribute to the work of the staff as well as the directors and governors. On behalf of the Department, I would echo his comments. He also raised important points about the transition period, the specific needs of children, the ambulance service and the review of maternity services, and the significant point that Stafford appears to be demonstrating that it is perfectly possible to be a thriving local acute hospital. I shall try to deal with all my hon. Friend’s points, but If I do not, perhaps he will be good enough to allow me to write to him and deal with them properly that way.

The configuration of health services is an important issue for many hon. Members across the House and their constituents, particularly those who have previously experienced poor care from local health services. We all agree that all patients should receive high-quality, compassionate care. That is why the Secretary of State has made care a crusade in his leadership at the Department. We are all aware of the appalling lapses of care that were all too often received by patients at Stafford hospital in that terrible period.

The first of November marked a new beginning for local health services, with the dissolving of the Mid Staffordshire NHS Foundation Trust and the launch of the new University Hospitals of North Midlands NHS Trust. Over £250 million of investment is being put into health services in Staffordshire, including significant investment into County hospital.

Past events at Mid Staffordshire will not be allowed to cast a shadow over the future of health services in Stafford. Thanks to the hard work of many, not least my hon. Friend the Member for Stafford, County hospital has a bright future and will offer modern, safe, sustainable services for local people now and in the future. As my hon. Friend has said, much progress has already been made and significant investment is being made in health services in Staffordshire to ensure that that progress continues. The current service specification at University Hospitals of North Midlands NHS Trust is that recommended by the trust special administrator and has been subject to consultation and endorsed by the Secretary of State for Health. Changes to the service specification will only occur on the grounds of patient safety.

Let me reply to the specific points made by my hon. Friend the Member for Stafford. Accident and emergency departments are often the most visible hospital service, and local people therefore often focus on A and E services when looking at changes to their local hospital. Local protests have been held on the grounds of County hospital against the transfer of services. There has been some speculation that A and E at County hospital will be downgraded. Let me take this opportunity to say that that is not the case.

The A and E service will continue to operate 14 hours a day, seven days a week. In fact, thanks to significant investment, the A and E department at County hospital will double in size and have a dedicated space for treating children. That expansion will address overcrowding. The number of staff working in A and E will increase and all consultants working in the department will be trained in paediatrics.

I understand that my hon. Friend and some of his constituents would like County hospital to operate a 24-hour A and E service. It is important to note that the A and E in Stafford has operated 14 hours a day since overnight services were removed in 2011. Of course the decision to close A and E overnight was taken in the interests of patient safety.

Work by the trust special administrators has confirmed that a 24-hour consultant-led A and E remains unsustainable at this time. However, a GP-led service is planned to operate overnight in County hospital from April 2015. Therefore, those patients with conditions that are not life-threatening but that require medical treatment or advice will not need to travel outside of Stafford, no matter the time of day or night. I understand that work by local commissioners is under way to look at the possibility of an interim solution until 2015.

Investment is being made to improve A and E performance across the University Hospitals of North Midlands NHS Trust. Indeed, £80,000 of winter money has been allocated to an improvement plan that aims to have the trust consistently meeting the A and E target by March 2015. In total, £4.5 million will be invested in supporting A and E performance at the trust and a further £4 million across Staffordshire.

My hon. Friend mentioned the West Midlands ambulance service. The continued good performance of that service will be important to ensure success in both service transitions and to improve A and E performance. WMAS has been thoroughly involved in planning, and my hon. Friend has had regular and productive meetings with Dr Anthony Marsh, the trust’s chief executive.

Of course, as with all other ambulance services, WMAS is dealing with increasing demand, but I can assure my hon. Friend and his constituents that WMAS is fully engaged in the changes across Staffordshire. As he knows, A and E hours were reduced in 2011 in the knowledge that the ambulance service could and would ensure that patients were taken to neighbouring hospitals.

[Jeremy Lefroy]

I am grateful to the Minister for that reassurance. I pay great tribute to the staff, paramedics and everyone at WMAS—they do a fantastic job—but sometimes what is said at the top of the service and what is actually going on at the bottom are slightly different. I am not trying to point the finger at anyone. Everyone is trying to do their best. People do not want to admit sometimes that there are real capacity problems, because they want to be seen to be getting on with the job. I ask the Minister to look at this case quite closely, particularly as the indicators have been red for so long.

[George Freeman]

My hon. Friend makes a really important point, and I shall be happy to look at it, as he suggests.

Ambulance diversion from Stafford to larger hospitals for life-threatening conditions—stroke, cardiac arrest or serious trauma—had been in place for some time before the overnight suspension, as my hon. Friend will know. In other words, the ambulance service already has a number of years’ experience of these arrangements. The local clinical commissioning group commissioned additional ambulance service provision to cover both overnight and daily divert activity. That extra provision will remain in place.

Stafford & Surrounds CCG reports that the ambulance service’s performance on the red 1 target in its local area has shown a general upward trend. The target was met in six of the eight months between January and August 2014, and the figure was 77.8%, against a 75% standard, in August 2014. The red 1 target measures performance on the most critical calls that the ambulance service receives: calls to patients in immediately life-threatening situations where a rapid response is vital.

Across the whole trust area, the service met all three performance targets in September 2014, the latest month for which centrally verified data are available. Its performance on red 1 calls was 83%, against a 75% standard. It also met the red 1 and category A19 standards in the six months between April and September.

As I know from my Norfolk constituency, rural areas, such as those served by large parts of Stafford & Surrounds CCG, present challenges to ambulance services across the country. West Midlands ambulance service and local commissioners are working together to ensure that the ambulance service continues to cope with the changes in Stafford and the wider challenges of serving a rural region at a time of increased ambulance pressures across England.

I will touch on the transfer of maternity services. Early next year, in line with best practice guidelines, some services will transfer from County hospital to the Royal Stoke University hospital. That will begin on 16 January 2015 with the temporary transfer of consultant-led maternity services. A stand-alone, midwife-led maternity service will open at County hospital.

[Jeremy Lefroy]

We were given assurances that no services would be transferred without the double lock, which assures that the capacity and safety of the services would be guaranteed in the case of transfer. We now have a specific date for the transfer of services. When can we see the evidence of the double lock for safety and capacity?

[George Freeman]

My hon. Friend makes a good point. I will undertake to look into that and get back to him.

Women who require care provided by an obstetrician or anaesthetist will be cared for in Stoke, and transport between the two hospital sites will be improved. Those changes to maternity services are temporary, as I have stressed, pending the outcome of the review, which is due to report in June 2015. Other services will transfer permanently to Stoke, including acute and emergency surgery, which will move in February 2015. In-patient paediatrics, including in-patient paediatric surgery, will move by the end of March 2015.

These decisions are made in the interests of patient safety. Let us not forget that the root of past problems was unsafe services at Stafford. The local NHS, led by local doctors, has therefore made the decision to transfer services based on clinical evidence, with patient safety rightly at the forefront of all decision making.

Consideration has also been given to patients’ wider needs and travel distances. For example, the movement of in-patient paediatric services will create access to high-dependency services and intensive care and to tertiary specialist opinions, reducing the need for patients to travel to Birmingham. Provision will also be made for parents to accompany their children to Stoke when travel is required out of hours, including supplying accommodation if needed.

It is understandable that people have concerns when change is proposed. I have no time for those who want to frighten patients in the face of change. It is important to remember that change is sometimes needed to ensure the best outcomes for patients. We know that there were serious failings at Stafford, and it is important that the University Hospitals of North Midlands NHS Trust is able to make changes to services where they will benefit patients and ensure that County hospital provides the high-quality, safe care that local people deserve.

Turning to the future of County hospital, over £250 million is being invested in health services in the years ahead. The hospital’s A and E department will double in size and see an increase in its staff numbers. Out-patient facilities will be expanded, particularly for emergency access clinics. Wards and operating theatres will be refurbished and upgraded to be fit for 21st century medical care. There will also be new services, including a £1.2 million MRI scanner that will offer advanced diagnostic services in Stafford for the first time, which means that more than 6,000 patients who currently travel to Cannock and Stoke will be treated closer to home. Eye surgery, orthopaedics, dermatology and a new assessment unit for frail elderly people are also services that County hospital will begin to offer.

Progress is already well under way. On 1 November the Mid-Staffordshire NHS Foundation Trust was dissolved and County hospital joined the Royal Stoke University hospital under the new University Hospitals of North Midlands NHS Trust. Thanks to the hard work of many people, the process of transferring County hospital to the new trust has gone smoothly. A number of assurance processes were in place leading up to the transfer, including oversight and scrutiny of the quality and safety handover documents. That process has been overseen by the local transition board, chaired by Sir Neil McKay, an independent chair who is accountable to the CEO of the NHS Trust Development Authority. The local transition board will continue to provide oversight to ensure the safe implementation of the new service model at the new trust.

Finally, turning to CCG funding, in December 2013 NHS England adopted a revised funding formula for local health commissioners that more accurately reflects population changes. The new funding formula is based on up-to-date and detailed information and takes into account the three main factors in health care needs: population growth, deprivation and the impact of an ageing population. All CCGs have received a funding increase matching inflation for 2014-15.

The people of Staffordshire were badly let down by the local NHS in the past. The appalling difficulties that were too often uncovered gave people in the area reason to fear for the future of the hospital and to be very disappointed, rightly, at the level of service that was provided. The local NHS has worked hard to address the failings in care and to bring about substantial improvements. I pay tribute to the work it is doing. The opening of the new trust on 1 November marked a new beginning for the NHS in Staffordshire. I want to put on record the debt we owe to all those who have worked so hard to get the hospital turned around.

There is still work to be done to ensure that services in Staffordshire are of high quality and sustainable. My hon. Friend has encouraged his constituents to support County hospital and to access local treatments where appropriate, and I give the same message here today. Local engagement and support are key to the development of local services. I assure him that if his constituents are anxious about the quality of services, they can be sure that County hospital in Stafford will be under a level of public scrutiny that nowhere else in the NHS has seen. In my hon. Friend, the people and patients of Stafford could have no more doughty a champion.

Question put and agreed to.

Health and Social Care (Safety and Quality) Bill

Debate between George Freeman and Jeremy Lefroy

Friday 7th November 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I am delighted that this important Bill appears to have cross-party support. I strongly support it, as do the Government, and I pay tribute to the tireless commitment shown by my hon. Friend the Member for Stafford (Jeremy Lefroy) to the cause of public safety. I think that I speak for the whole House—although many Members are not present this morning—when I say that he has commanded all our respect in campaigning so tirelessly, with such good grace and diligence, and with cross-party support to ensure that the lessons of the appalling tragedy at Mid-Staffs are properly learned. He has demonstrated the integrity of that work again today, which is reflected in the degree of support for the Bill.

Let me begin by echoing the support that my hon. Friend expressed for Julie Bailey, my hon. Friend the Member for Stone (Sir William Cash) and Ken Lownds, all of whom have done a huge amount of work behind the schemes in support of the Bill and the wider cause of patient safety. My hon. Friend spoke extremely powerfully about the 4,000 unavoidable deaths and the many thousands more unavoidable incidents of harm. Such incidents will, of course, be avoidable if we are better equipped to track, monitor and collect data in the way that is proposed in the Bill, and to develop the culture of transparency and accountability for which it provides.

My hon. Friend spoke about the concept of zero avoidable harm, which sits at the heart of the Bill, and spoke particularly powerfully about the culture of health and safety. In the aviation and nuclear industries, as we heard from the hon. Member for Copeland (Mr Reed), it is a culture that involves actively looking out for near misses, and actively welcoming the reporting of problems by staff members from top to bottom of an organisation as soon as they have been identified, that has enabled those industries to develop such exemplary health and safety records. One of the great lessons that emerges, loud and clear, from the Francis report is the need for a change of culture.

My hon. Friend referred to the science of safety and the elimination of variability from the system, and to the good work that is being done in this country, not least as a result of the Francis report. That is another example of an area in which the NHS is leading in global medicine. He also spoke of the importance of integrating information and data. His account of the journey made by his constituent Janet Powell as she helped to escort her mother across the health and care landscape will have resonated with many Members. It certainly resonated with me, because over the last 18 months I have been in a similar position, supporting my own mother through a journey from primary care to hospital care to community care in Norfolk. As many Members and many millions of carers outside will know from experience, it is often the carers, parents and loved ones of patients who are carrying the best information about the patient through the system. That information is often too slow and does not keep up with the patient on their journey.

My hon. Friend spoke very powerfully about the risk-averse attitude to sharing information. That is a problem, and the Government are committed to trying to tackle it. That is another reason why we are supporting this Bill. Key to that, as my hon. Friend touched on, are the recommendations of Dame Fiona Caldicott, and I am delighted that she has agreed to take a lead role and to accept the invitation of the Secretary of State to look at the safeguards we need to be putting in place across the whole of the NHS and Department of Health care and data provisions. That will help provide a strong degree of reassurance to both Members in the House and people outside that patient concerns about confidentiality are being met.

My hon. Friend also spoke very powerfully about his support for health care professionals, and I would like to put on record my support for his comments about the NHS staff who are in Africa on the front line of the fight against Ebola. We owe them all a huge debt of gratitude.

We also heard from a number of other Members who spoke very powerfully. My hon. Friend the Member for Bury North (Mr Nuttall) was kind enough to congratulate me on my role in managing to get the data-sharing measures included in this Bill. They were raised before this House in my ten-minute rule Bill, which fell, but I am delighted to see those measures picked up in this Bill.

My hon. Friend also spoke very powerfully about the NHS as a bedrock of British society, and I could not agree more. He made some interesting points, too, about the difference between the science of health care and the human and compassionate and cultural side of health care, which this Bill goes right to the heart of. That has always been a great strength of the NHS, which in its founding charter is a scientific and research-led organisation, and which has always put compassionate care at the very top of its mission.

My hon. Friend the Member for Congleton (Fiona Bruce) spoke very powerfully and again paid tribute to both the NHS and its staff. She also spoke about the importance of transparency and of there being public confidence in the data confidentiality aspects of this Bill and more generally across the health care system.

I was pleased by the tone and spirit of the speech of the hon. Member for Copeland and to hear that there is cross-party support for this Bill. Although parliamentary time is short in this Session, I think that with that support this Bill has every chance of reaching the statute book.

I was particularly pleased to hear the hon. Gentleman’s powerful—and personal—support for the importance of data sharing in 21st-century health care. He rightly highlighted Salford as a beacon of what can be achieved, and that stands as a tribute to the NHS in the north-west, which is leading the way in the use of informatics and medical data for both research and treatment.

The hon. Gentleman also spoke powerfully about his personal experience as a diabetic patient, and about his reliance now on data as a patient and his active embrace of telehealth and the use of smartphones. He also spoke very powerfully about how that is allowing him to have better control of his condition. Patient empowerment, through data and electronic health records and putting in place a landscape so that patient medical information flows with the patient and reflects the patient journey across the system, is key to both this Bill and the Government’s wider proposals for building the integration of health and care and a 21st-century model of the NHS in which health care moves from being something done to patients when the system is able to do it to a system in which active health citizens are empowered and enabled and encouraged to take more responsibility for their health care so they can drive through the system in the way that suits them.

We might not have a packed House here on this Friday morning, but we have certainly packed in the arguments. We have heard a lot of high-quality contributions. I want to talk about the thinking behind the Bill and answer some of the key questions that have been raised.

The need to maintain minimum levels of quality much more consistently was put into sharp focus by the landmark public inquiry report, published in February 2013, on the terrible, shocking and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust. I think everyone in the House would accept that the subsequent Francis report shook the health system to its core. Francis’s call for a fundamental culture change across the entire health and social care system that would put patients first at all times still resonates loudly in this Chamber and throughout the health and care debate.

Sir Robert Francis QC, the chair of the inquiry, made a compelling call for action across six core themes: culture; compassionate care; leadership; standards; information; and openness, transparency and candour. That is a checklist that all of us who are involved in health care need to keep close at hand. The inquiry represented a watershed in our thinking on safe and better care. That in turn is driving a culture change across the NHS as we resolve never again to allow the system to fail patients and service users in the shocking way that it did.

The Government published their response to Robert Francis’s public inquiry on 19 November 2013. That response, “Hard Truths: The Journey to Putting Patients First”, demonstrates the Government’s commitment to creating a culture of openness, with greater accountability and a relentless focus on safety in an NHS that puts compassion at its heart. In response to the events at Mid Staffs, to Robert Francis’s recommendations and to Don Berwick’s excellent review of improving patient safety, the Government have already introduced a number of measures to improve safety. First, a new statutory of candour on providers will help to ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation. This new duty will be overseen by the Care Quality Commission. It will come into force for all NHS bodies soon and for other registered providers by April 2015. We expect staff to reflect the duty in their everyday activity.

An organisation is made up of its staff, and providers will be expected to implement the new duty through staff across their organisation. Training and education of staff will also support the establishment of an open culture. The General Medical Council, the Nursing and Midwifery Council and the other professional regulators will introduce a new explicit and consistent professional duty of candour, making clear a requirement to be open, whether the incident is serious or not.

Secondly, the Secretary of State announced in March a new Sign Up to Safety campaign, a platform on which all NHS organisations and patients can share, learn and improve ideas for reducing harm and saving lives. It was launched in June, and health care leaders have been invited to set out what their organisations will do to strengthen patient safety, including by producing a safety improvement plan. Sign Up to Safety aims to achieve much more than just the numbers of NHS organisations joining; it is about motivating participants actively to get involved. The campaign will go beyond institutions and seek to sign up as many individual NHS staff as possible, and everyone who chooses to join will commit to the new patient safety ambition.

In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality have established a new national patient safety collaborative programme. This will spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country. The safety collaboratives will be supported systematically to tackle the leading causes of harm to patients. The programme will include establishing a patient safety improvement fellowship scheme to develop 5,000 fellows in a national faculty within five years.

We are absolutely committed to changing the culture of patient safety through investment in leadership. NHS England is now working with The Health Foundation to help develop proposals for a safety fellowship initiative. The NHS is on a transparency journey, through the NHS Choices patient safety section, to become completely open and transparent. More information about our local health services is now more publicly available than ever before. As well as using the information to drive improvements, it is vital that a patient or member of the public can easily find and understand what it says about their local health services.

In June, NHS Choices began publishing new and existing information in a new safety section, complementing the wealth of information available about our hospitals and wards. It specifically provides information on: nurse staffing levels, including at ward level; infection control and cleanliness; CQC national standards; whether the unit is recommended by staff to their relatives and friends; patients assessed for risk of blood clots; the response to patient safety alerts; and open and honest reporting. The NHS is one of the safest health care systems in the world but there is always scope to improve health care standards universally and reduce avoidable harm further. That is why the Secretary of State for Health set the ambition to reduce avoidable harm by half and save 6,000 lives over the next three years.

As well as the devastating effect that health harms can have upon patients, service users and, as hon. Members have mentioned, their carers and families, a recent report by Frontier Economics has estimated that poor care could be costing the NHS up to £2.5 billion every year. That is why the Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients.

[Jeremy Lefroy]

I am grateful to the Minister for the argument he is developing. Does he agree that the Bill is vital for staff? They do not want to be involved in instances of avoidable harm; it preys on their minds and can blight their careers. If the institutions to which they belong are not seeking to avoid harm, it is often the professionals, rather than the institution, who carry the can, and that is not right.

[George Freeman]

As ever, my hon. Friend makes an incredibly powerful point. An institution is only as strong as the staff within it, and when an institution is not taking seriously an issue that the staff confront as a daily reality, it puts them in an impossible position. He rightly says that by changing the culture of the institution, NHS staff will be able to do their jobs more easily and with more confidence, safe in the knowledge that when they raise issues that may be of concern, whether or not there is in fact a risk, they will be welcomed and supported. That culture change is vital if we are going to turn things around in the way that we are committed to doing.

There are three key sets of provisions in the Bill: the ones that will mandate patient safety as a key requirement of CQC registration; the provisions ensuring the integration of data across the health and care pathway; and the provisions dealing with the regulation of professional standards. They represent real and significant steps to support and develop patient safety in the NHS, and we are delighted to support them. Let me deal with each of the three in turn.

On the CQC requirements to include safety, clause 1 is central to the Bill’s focus on safety and quality, and, in particular, the elimination of the avoidable harm that flows from the provision of poor care in health and adult social care services. Safety is paramount and must be the focus of care providers at all times. The experience at Mid Staffs underlines the importance of that and of what can happen when providers put other priorities before safety. The CQC’s role in protecting patients is vital, and safety and the avoidance of harm are key elements of the CQC’s regulation of providers, in two key ways. First, monitoring registered providers against safety requirements and taking enforcement action when the requirements are not met is central to the CQC’s objective to protect and promote the health, safety and welfare of people who use services.

[Jeremy Lefroy]

Does the Minister also agree that the Bill’s provisions, in seeking to get that focus right to the top and make it the responsibility of the Secretary of State, ensure that, right here in this House, patient safety is of the essence?

[George Freeman]

My hon. Friend makes another important point about the role of leadership in the culture change that we are seeking to drive. I believe all hon. Members would acknowledge the Secretary of State’s personal commitment to this crusade for patient safety, and it is symptomatic of the level of leadership that is required. If the leader—the accountable senior executive—in every trust and organisation in the NHS makes clear their personal commitment to this agenda, it helps to change the culture and to create the conditions in which the reporting of patient safety issues and concerns is welcomed and encouraged.

Safety is also a critical component of the CQC’s new inspection regime and one of the five key questions the chief inspectors ask when rating the quality of services. Currently, it is at the Secretary of State’s discretion as to whether registration requirements should cover safety of care. Clause 1 removes that discretion and instead places a duty on the Secretary of State to impose registration requirements about safety of care. We welcome that duty, because it absolutely fits with the Government’s wider commitment to putting patient safety right at the heart of our health and care system. The duty will cover all providers registered with the CQC across health and, importantly, adult social care, and will help ensure that no avoidable harm will come to patients and service users when they are being provided with a regulated service. It is important to say at this point that the duty will not place an obligation on the Secretary of State to ensure that care or treatment is risk-free—no Secretary of State could ever give that undertaking. Health care provision is of its nature a risky business and can be so. Chemotherapy, for example, saves lives but can have significant side effects. A test of reasonableness must be applied in assessing whether harm is avoidable. The registration requirements that are before Parliament do cover safety and will allow the CQC to take action against poor providers in a way that has not been possible up to now. The Government therefore welcome the clause, which reinforces what the regulations are seeking to achieve and will ensure that the key message of safety and harm reduction runs consistently through the CQC regulation, and across the system as a whole, for years to come.

Clauses 2 and 3 deal with the key changes requiring a common identifier and imposing the duty to inform other health care professionals along the care pathway. Far too often in the health care system, patients lead and their information follows and, particularly as patients migrate between primary, hospital and community care, they and often their loved ones are left driving the patient journey without access to the necessary information. Too often, the health care professionals do not have access to the very latest information on the treatment that their patient has received in another part of our health and care system. That is why we welcome the clauses.

Clauses 2 and 3 concern the sharing of information by providers and commissioners to support people’s direct care and treatment, as an essential part of the delivery of safe, effective and high-quality care. The sharing of timely, accurate and relevant information facilitates the provision of integrated care and treatment tailored to people’s needs and wishes, yet we know that that sharing does not always happen as it should. Anxiety about information governance and data protection can stifle the sharing of information between staff and organisations working together to care for an individual. Clauses 2 and 3 will require that providers and commissioners of publicly funded health and adult social care share the information which is so essential to the delivery of safe and high-quality care. That will relate only to the way in which information is shared by organisations directly involved in an individual’s direct care.

Clause 2 places a duty on providers and commissioners, within scope, to record and use consistent identifiers in people’s health and care records and correspondence. There is a requirement to include the identifier when sharing information with other organisations directly involved in that individual’s care. Clause 3—

--- Later in debate ---

[George Freeman]

It is important to recognise that clauses 2 and 3 relate only to how information is shared by organisations involved in an individual’s direct care. My hon. Friend made the point that this Bill is solely focused on the needs of the patient; it is not in any way about the Government or the NHS seeking to collect information for any other purpose other than to ensure that patient care is first and foremost in the system.

Clause 3 places an express duty on direct care providers and commissioners of publicly funded health and adult social care. When providing care to an individual, organisations within scope would be required to ensure that the relevant information is shared with staff within their organisation, and also within other organisations along the care pathway, where it is in the individual’s best interests. That duty would apply only if it directly facilitated the individual’s care and if it was in his or her best interest. That will not only support the delivery of safe, effective and integrated care, but improve people’s experience of their care and support, sparing them the frustration of having to tell their story over and over again as they move along the care pathway.

Simply sharing is not enough. To realise fully the benefits of sharing information, it is vital that the information shared is accurate, relevant and timely. In order to provide safe and high quality care, especially where it is urgent or where multiple care teams are involved, information needs to follow the person, so that professionals can access the right information at the right time. Using a consistent identifier is essential to that aim, as it ensures that the information being shared relates to the right individual.

A number of people have asked about the common identifier. Clause 2 places a duty on the Secretary of State to make regulations that will specify the consistent identifier to be used. It is the intention of the Government that the prescribed identifier should be the NHS number.

The universal use of the NHS number is a long-standing priority of the Department. Ensuring that records include a person’s NHS number, especially when they move between providers on their care pathway, is vital to the safety and quality of care. A number of Members asked about our view of the appropriate identifier. We believe that consistent use of the NHS number will facilitate the co-ordination of care, reduce errors and support the integration of records.

Ensuring a reliable and seamless transfer of information is all the more vital when the patient is a vulnerable person. That vulnerable person could be an elderly patient with dementia and many complex needs, for whom large institutions can be difficult to navigate at the best of times. I must stress that these duties are strictly limited to sharing for direct care purposes, with only those organisations directly involved in the provision of care, and only where it is in the patient’s interests.

Let me be clear: this will not permit or require sharing of information for any other purpose. The duty would not apply where there were good reasons for it not to apply. Such reasons could include: when an individual objects to his or her information being shared, or to his or her NHS number being used; where the individual would be likely to object; or when an individual receives, or may receive, services, such as sexual health services, anonymously.

[Jeremy Lefroy]

Should this Bill command the support of this House on Second Reading, does the Minister agree that one thing we would need to consider in Committee is this real issue of the mixing up of personal information and patient information within records? How best that can be addressed will require quite a lot of discussion.

[George Freeman]

My hon. Friend makes an excellent point. As he is aware, there are a number of initiatives on data across the health and care system, which is why the Secretary of State has appointed Dame Fiona Caldicott to advise the Government and to look at the pilots that NHS England is currently running on the care.data programme. It is important that the data provisions of this Bill and the confidentiality provisions and guarantees are closely examined in Committee and that there is no confusion over the purposes for which the data provisions are being used, which are solely to do with patient safety.

Clause 4 creates a power for the Secretary of State to make regulations to exclude certain persons or their functions that would take them outside the scope of the new duties for continuity of information. The Government intend to make regulations that will exclude providers and commissioners of children’s social care and providers and commissioners of children’s health care within the Department for Education’s purview. Those exclusions will include local authorities and other organisations exercising educational functions and children’s social service functions, children’s homes and residential family centres, fostering and adoption support agencies and certain schools, nurseries and educational institutions. I am delighted to tell the House that the Department of Health and the Department for Education are working together to support information sharing and use of the NHS number, where appropriate, by those organisations.

The use of patient data can arouse significant public concern and controversy and lead to highly charged debates. The public rightly expect to see their data held securely and used only for their benefit. That sits full square at the heart of these proposals, which is why NHS England has taken back the care.data proposals to review, revise and pilot, and why we have appointed Dame Fiona Caldicott. The information-sharing provisions of this Bill are solely concerned with the sharing of information between health and care providers where it is in an individual’s direct care interests.

To summarise, the consistent patient identifier and information-sharing provisions will support three key things: better informed care decisions, leading to care and treatment being better tailored to people’s needs and preferences, and better health and care outcomes; safer care, with a reduced likelihood of errors, adverse events and sub-optimal care stemming from a lack of information;, and improved experience of care, with individuals being called upon less often to repeat their story, and having increased confidence that the person caring for them has all the information that they need.

Let me turn now to the third and final section of the Bill, which deals with the regulation for the Professional Standards Authority and the professional regulator. We welcome these clauses, which will bring in a consistent objective for the PSA and for the regulators of certain health and care professionals, including dentists, nurses, midwives and opticians.

That will ensure that public protection is at the heart of what the regulators do. This measure is about not changing what the PSA or the professional regulators do in relation to professional regulation, but ensuring a coherent, strategic approach by them in the performance of their functions. Patients and the public need to understand the role and purpose of the organisations that regulate our health professionals in order to have confidence in what the regulators do. Having clear and consistent objectives is vital to that.

Let me touch now on the automatic erasure provisions, which my hon. Friend said had been withdrawn. The intent of the policy is to enable the regulators automatically to erase from a professional register individuals tried and convicted of certain serious crimes. However, it would be necessary to amend the existing statutory framework for each of the regulators properly to achieve the policy and would result in a Bill that is much longer and more complex than is usually acceptable for a private Member’s Bill. In the light of that, and given the complexity of the drafting required to achieve the policy, we took the position that automatic erasure should not be taken forward.

Automatic erasure was one of the areas considered by the Law Commission in its review of the regulation of health professionals. The Government remain committed to legislating on this important issue at the earliest opportunity. We have explored all other possible legislative options for taking forward issues arising from that piece of work and therefore propose to take forward automatic erasure in a future parliamentary Session alongside other measures in response to the Law Commission’s review. The long title of the Bill, which sets its scope, specifically mentions the intention to provide for automatic erasure, but I believe that my hon. Friend the Member for Stafford has indicated his intention to table an amendment in Committee to remove that from the long title.

When I talk to people about the Bill, I am asked one or two key questions, which I believe those watching the debate will want to hear us answer, and which the hon. Member for Copeland has asked me to deal with. The first is, “Are my medical records already shared with others involved in my care?” Unfortunately, the sharing of information about one’s care is not as widespread in the system as it needs to be. Those who use the NHS the most often are often those who have the most to remember. It can be very frustrating for health professionals, and too often that lack of information is involved in the misdiagnosis and the mistakes that my hon. Friend the Member for Stafford spoke of.

The second question that we are often asked is, “Don’t these regulators already put patient safety at the heart of everything they do?” The CQC and the professional regulators are all there primarily to protect us. The measures in the Bill are not a reflection of any failure in that respect. However, these organisations are given legitimacy through legislation; their remit and ability to act are defined in law, and it is important, we believe, that their legislative basis is explicit about their respective roles and duties in public safety. It is not our intention that the Bill, if it becomes law, should result in a dramatic change to the way in which the regulators operate on a day-to-day basis. We know that they are already focused on patient safety. The Bill enshrines that focus and ensures that those organisations are never hindered in their important work.

The Bill is a big step forward. I urge hon. Members from both sides of the House to support it.

Later in the year, we shall publish a comprehensive update on achievements to date and the progress towards Sir Robert Francis’s vision of a system delivering safe, compassionate care.

The events at Mid Staffs were a shocking reminder of the systemic failings in patient safety and care that occur when the culture and practice of healthcare institutions cease to prioritise the human, the compassionate and the cultural aspects of health care. I am delighted to support the Bill, which fits very well with the Secretary of State’s crusade for accountability, transparency and patient safety. It complements the measures that we are putting in place, as a Government, to support patient empowerment, to integrate health and care, and to meet the need for seamless information that follows patients, rather than patients so often traversing the care pathway without that information to hand.

There are two other questions that I was—

Francis Report

Debate between George Freeman and Jeremy Lefroy

Wednesday 5th March 2014 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I was told by a senior member of the medical profession that the two Francis inquiries were the most important look at the NHS for at least two decades. He was right. The first, which was commissioned by the previous Government, revealed what Robert Francis describes as the

“appalling suffering of many patients”

primarily caused by a serious failure on behalf of the trust board, which did not listen sufficiently to patients or staff and failed to tackle an insidious negative culture involving a tolerance of poor standards. The second report, from the public inquiry commissioned by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), described how

“a system which ought to have picked up and dealt with a deficiency of this scale failed in its primary duty to protect patients and maintain confidence in the healthcare system.”

It is a tribute to those who fought long and hard against the odds to have the inquiries and reports instituted by the last two Governments that their importance is recognised.

[George Freeman]

Does my hon. Friend agree that one of the most shameful episodes highlighted by the Francis report is the consistent and persistent neglect of the whistleblowers in the service who tried to raise the issues that were being hidden, and the systemic neglect of their interests? Many of them are still suffering, and this is still going on in Wales today. Will he invite the shadow Secretary of State to acknowledge that the problem is ongoing?

[Jeremy Lefroy]

I agree. The treatment of whistleblowers has been a disgrace, not just at Mid Staffs but in many other places. I have seen consultant contracts from way back that have prevented their raising issues even with their Members of Parliament, and I am glad to say that sort of thing is coming to an end. I want to try to focus as much as possible on the Francis report, however, as I believe there are many important lessons that all of us, including me, have to learn.

As the Health Committee has said, as a consequence of the issues I have outlined,

“a healthcare system established for public benefit and funded from public funds risks the undermining of its guarantees of safety and quality.”

It is my sincere hope that we never have the need for another inquiry of this nature. This should mark a watershed in the NHS—a time when patient safety and high-quality compassionate care is the rule, delivered through a positive and caring culture, underpinned by safety and quality management systems through our health service and backed by openness and accountability, which I am sure many Members will speak about later. It is thus that we can respect the memory of those who suffered at Stafford, but also in many other places across the UK, as the work of the right hon. Member for Cynon Valley (Ann Clwyd) has shown.

The Francis reports, and particularly the accounts of patients’ experiences, should be required reading for all medical and nursing students. I ask the Secretary of State to confirm that he will pursue that with Health Education England.

Robert Francis, for whom I have the greatest respect for the calm and understanding way in which he conducted the inquiry, made 290 recommendations, but I shall concentrate on his essential aims. He writes of fostering a common culture of putting the patient first. It is sad that he must write that, but it is necessary. However, before we rush to find fault with a service which has lost its way, let us just consider the society in which it operates, starting with ourselves. Can we honestly say that we always put our constituents’ interests first? What about others in the professional and business worlds? When self-interest and personal fulfilment are so often lauded, why is it that we expect the NHS to be so very different? Saying that is neither to excuse nor to lower the bar, but to understand how difficult it is in some circumstances to maintain that highest of standards. Ensuring that patients come first when dealing with several very ill and distressed folk, perhaps at 2 o’clock in the morning, takes more than just compassion. I am not downplaying compassion in any way—it is essential—but the underpinning of quality and safety systems carried through as second nature is also required. It means ensuring that the leadership is on call to provide extra help as soon as it is needed. It demands the strength to speak out for what is not acceptable and an openness to admit when there are problems. Without the systems and standards, the supportive leadership, the strength and the openness, not even an angel can always put patients first, much as they would wish to.

There has been much debate about staffing levels, and rightly so. Although the problems at Stafford went far beyond numbers, there is no doubt that cuts contributed to them. When I was first selected as parliamentary candidate in 2006, the trust had a £10 million deficit. It wanted to achieve foundation trust status and needed to balance its books, and part of its solution was to reduce the number of nurses. I should have questioned that, as should others, but we accepted the trust’s assurances that it would not harm patient care. I say to all right hon. and hon. Members that one thing that must come out of this report is that each of us must be emboldened to challenge our local trusts when they make statements such as, “This won’t harm patient care”, despite their cutting 100 or more nurses. The approach to staffing management and data publication used at Salford Royal NHS Foundation Trust has been held up as an example of good practice in staffing by the Health Committee and the Secretary of State, so let us act and adopt it everywhere.

I recall that when I was first elected to this House, I was shocked at the tone and content of some of the responses by the NHS to complaints. Not only did they take several months to arrive, but they were sometimes complacent, and they certainly lacked compassion and understanding. That has, for the most part, changed considerably for the better—it certainly has in Stafford. The overwhelming message I receive from my constituents who need to complain is that they are not interested in compensation, but they are interested in a better NHS for everybody. So let us approach the complaints system from their premise, not that of lawyers. That is the responsibility of the chief executive, who should review all complaints, and personally read and sign all response letters. The Secretary of State responds to several complaints each week personally and in this, as in many other ways, he sets the example.

Although I am encouraged by the progress made in treating complaints, I am less confident about accountability.