NHS Risk Register

Jeremy Lefroy Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

Of course, there are lessons to be learned for those in all parts of the House when the Francis report is published, and I can say, on behalf of Labour Members, that we will learn those lessons. However, this Bill goes to the heart of what happened in that case, because it is about autonomy in hospital services, and we know that when one makes an organisation autonomous it can sometimes fail as well as get better. I cannot understand how the Government can be legislating before they have even waited to hear the conclusions of the public inquiry that they set up. Surely that has implications for the Secretary of State’s Bill. Why has he not waited to hear what it says so that it can be properly reflected in the design of the service that he is creating?

[Jeremy Lefroy (Stafford) (Con)]

Given that the right hon. Gentleman opposed the public inquiry at the time, will he now agree with Government Members, particularly the Secretary of State, that it was vital that it took place and that the lessons be learned?

[Andy Burnham]

One of my first acts as incoming Health Secretary was to commission Robert Francis QC to conduct an independent investigation into the events at Stafford on a local level. [Interruption.] Government Front Benchers are saying that it was not a public inquiry. They are right, but let me explain why. I did not commission a full public inquiry because, in my judgment, such an inquiry at that time, with all the glare and focus that it would bring to the hospital, would distract the hospital from its more immediate priority of making services safe as quickly as possible. I said to the chairman of the independent inquiry that if, at any time, he wanted to come back to me and ask for powers to compel witnesses, I would be well disposed towards receiving such requests. Given all the events that have taken place, to hear that the hospital is again having difficulties—that the A and E department is temporarily closed—gives me genuine cause for concern that the fundamental and far-reaching problems there have not been adequately addressed. That should concern us all.

I was talking about the risks identified by the NHS Northamptonshire and Milton Keynes risk register regarding the loss of capacity and problems in carrying out statutory functions resulting from the chaos caused by the Bill.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

The subject of this debate is risk within the NHS, specifically that associated with the Health and Social Care Bill. I want to address the matter with specific reference to Stafford hospital. My constituents, whether patients, relatives, loved-ones or NHS members of staff, have been through a great deal over the past few years. There is tremendous support for a quality acute hospital and the services that it provides in Stafford, including full-time emergency care, which it currently does not provide. The existence of that support is evidenced by a petition signed by 20,000 people. Those people need to know that the Bill will not hinder but support their ambition. I would like to show why it will support it.

The other great legislative influence on the future provision of NHS care in the coming years will be the report from the Robert Francis public inquiry into all the aspects of the troubles that surrounded the hospital. I am glad that the Secretary of State ordered that inquiry. He deserves credit for doing so. Indeed, his predecessor as Secretary of State, the right hon. Member for Leigh (Andy Burnham), also deserves credit for ordering the previous inquiry, which drew many valuable conclusions. Since those came to light, they have had a great impact on the Health and Social Care Bill. I will give three examples.

First, the Bill places a duty on the Care Quality Commission—the successor to the Healthcare Commission—and Monitor to work together closely. As Francis said, the absence of that duty was one reason for the troubles at Stafford and why the trust got the authorisation that it should not have got. Secondly, clause 2 places a duty on the Secretary of State to improve and promote quality throughout the NHS, which is vital. Thirdly, the Bill will strengthen local accountability for health services.

Francis will report soon—possibly while we are still considering the Bill—and as the right hon. Member for Exeter (Mr Bradshaw) said, we have to ensure that as many of those recommendations as possible are addressed in the Bill or very soon afterwards, perhaps in other legislation. A senior member of the Royal College of Physicians described the report to me as undoubtedly the most important review of the NHS in the past two decades, so it is vital that its recommendations are carried through.

In Stafford, we have seen at first hand the risks within the NHS. These risks, and their consequences, predate the Bill. The greatest risks that any health care system has to address are the safety of patients, the quality of care and the financial sustainability of services. The three are inextricably linked.

[Mr Marcus Jones]

Does my hon. Friend agree that part of the problem with Stafford hospital is the same as the problem at the George Eliot hospital in Nuneaton, Warwickshire? A PFI hospital built in close proximity has been a huge drain on the local health economy and has starved smaller district general hospitals of resources.

[Jeremy Lefroy]

I want to come to that point, although I should point out that people are grateful for the new hospitals built under PFI. I would not take anything away from that. It is the financial arrangements around them that have caused problems in some cases.

Much more work needs to be done on tackling the risk of harm to patients and ensuring patient safety. Local accountability, which the Bill strengthens, is important. Clinical commissioning groups will not commission services for their patients if they do not have confidence in them, but they have a responsibility to work with those providers so that confidence can be restored—they should not just ditch them. Transparency in the reporting on and reaction to adverse and serious incidents is improving, but under the Bill, with the health and wellbeing boards, HealthWatch and the CCGs, there will be groups taking a direct interest in what is happening in their local area.

Since the troubles at Mid-Staffordshire, all parties have focused on quality of care. I welcome the improvements at Stafford. There is still much more to do, but the staff have done a tremendous job moving things forward. However, there is a serious problem nationally, as was highlighted by the recent CQC report commissioned by the Secretary of State. We would all agree that it is not acceptable that elderly and vulnerable people are left unattended when they need help in hospital. We still get such cases, even today. That is why the Health and Social Care Bill’s requirement for the Secretary of State to improve the quality of services is so welcome. Making that a requirement will not in itself solve the problem, but it will ensure that the Secretary of State has a legal duty to deal with problems in the quality of care.

Then there is the question of financial risk. In Stafford, we face the problem at first hand, with a £20 million deficit this year. I am grateful to the Government for supporting us in that, and for their support in so many other places. However, we face great challenges, along with many other small acute trusts across the country, and we would under any Government. Let me make it clear: acute district general hospitals are an essential part of the health economy of this country, wherever they are. For the sake of towns and smaller cities across the country, we must, as a Parliament, find a model for them that works. Clause 25 of the Bill enhances local involvement in the commissioning of services. That will help the process, but it will need to be a robust process. When the consultations that are envisaged take place, they must be real, and they will be real: CCGs live in the communities for which they will be commissioning and they should know more than anybody about what their patients need.

The final risk cannot be legislated for, and no risk register will ever deal with it. If compassion for patients is lacking—if they are seen as numbers, not as people; if the elderly and vulnerable are considered a burden and somehow less important than the young and fit—we will have failed, however well funded our services are, however strong and shiny our new hospitals are, and however complete our risk register is. However, I am confident that we will not fail.

[Several hon. Members]

rose—