Accountability and Transparency in the NHS

Jackie Doyle-Price Excerpts

Thursday 14th March 2013 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

It is a pleasure to follow my hon. Friend the Member for Harwich and North Essex (Mr Jenkin) and give a south Essex perspective on this issue by speaking about the Basildon and Thurrock Foundation Trust. It was found to have significant failings and high mortality rates in 2009, which led to regulatory intervention, on which the right hon. Member for Leigh (Andy Burnham) will recall delivering a statement to this House. At that time, the Care Quality Commission voiced its lack of confidence in the management at Basildon, but there was no change and no one was held to account.

As we all know—and as my hon. Friend has eloquently explained—institutions fail when they are poorly led. In the event of failure, senior management need to step up to the plate, either to take a grip of matters and force change or to take responsibility. The failure in accountability at that time has no doubt held Basildon back. Subsequent CQC inspections found Basildon failing in terms of care and welfare, safety of premises, safety and suitability of equipment, nutritional standards, dealing with serious incidents, record keeping and cleanliness. That is simply not good enough.

When I challenged the hospital management, the response was invariably, “We’re no worse than anyone else; we just get more scrutiny.” Indeed, in one letter the then chief executive criticised the sensational reporting of some unnecessary deaths at the trust and asked for my assistance in acquiring more positive media coverage, a clear example of the complacency to which the Prime Minister referred when he made his statement to the House on the Francis report. There simply has not been sufficient urgency in addressing weaknesses. That led me to conclude that the trust would not improve without a change in leadership—the same conclusion the CQC reached in 2009.

I also have some wider reflections on the systems of governance. At Basildon, the board clearly failed in its duty to provide effective challenge and to hold the management to account. I think that we need to give a clear indication to directors of foundation trusts that in the event of poor performance, the buck stops with the board. They are accountable and they need to accept that responsibility.

I must say that I found the CQC a very positive ally in seeking better performance at Basildon. I know that it has been criticised by some Members, but my feeling is that its powers were quite limited. It certainly had no power to hold senior management to account, a power that is reserved for Monitor. My right hon. Friend the Secretary of State has made his comments about the CQC, but I think that he really needs to look at Monitor. In my experience, the work of Monitor has been very disappointing. In Basildon it was not keen to take any enhanced action. Its view was that the trust was not doing as badly as it had been in 2009 and so the direction of travel was positive, even though it was failing to meet the basic standards of care that the public should be able to expect. I do not think that is good enough. It goes to the heart of what we are debating today: the collective failure of institutions in the NHS to hold people to account when things go wrong. I urge my right hon. Friend to look at whether Monitor is really fit for purpose.

Since I started challenging Basildon and Thurrock NHS Foundation Trust, I have been very heavily criticised, as if by holding the hospital to account for its performance I am attacking the NHS and its staff. The contrary is true. If we really believe in the NHS and in providing the best possible health services for our constituents, we must challenge it when things go wrong. We should have zero tolerance of failure. Do we not owe it to the staff who do their job well to ensure that those who do not are disciplined and held to account for poor conduct?

Thankfully, Basildon and Thurrock NHS Foundation Trust is now under new leadership. There are new non-executive directors who will provide a challenge. We have a new chairman, a new chief executive and a new medical director, and I am encouraged by the messages I have received from them. However, when senior management have been excusing poor practice for so long, there is a need for profound cultural change to get things fixed. An NHS with a stronger emphasis on accountability would have allowed us to start that process in Basildon so much sooner and to save many lives.