Care Bill [Lords]

Joan Ruddock Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress.

When problems are uncovered, action must be swift. Robert Francis cited confusion over which part of the regulatory system is responsible for dealing with failing hospitals, so this Bill makes it clear where the buck stops. It is the CQC’s job to identify problems and instigate a new failure regime when it does so. Monitor and the Trust Development Authority will then be able to use powers to intervene in those hospitals, suspending foundation trusts’ freedoms where necessary to ensure that appropriate action is taken. If, after a limited period, a trust has failed significantly to improve, the Bill requires a decision to be taken on whether the trust needs to be put into special administration on quality grounds—and, yes, where necessary, a trust special administrator will be able to look beyond the boundaries of the trust and consider the wider health economy. As we know from Lewisham, that is not easy, but we will betray patients if we do not address failure wherever it happens.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

Why, when the Secretary of State and the Prime Minister have clearly set out the four tests that have to be met for any downgrading of hospital services, is he now introducing this clause? Those greater powers will totally undermine the clinical commissioning groups that his Government set up to meet local clinical and health needs, and not to balance the books for people outside their area.

[Mr Hunt]

I recognise that the right hon. Lady campaigns hard for her constituents. The four tests set out by the Prime Minister were never designed to require unanimous support from local CCGs for necessary changes. If we had to secure that, it would be virtually impossible to make any major reconfigurations. Where there is a failing hospital, it is important to resolve and address situations. There are exceptional occasions when that cannot be done in an individual trust’s area. The change in the law will not apply retrospectively to Lewisham, but it is right to ensure that, if we are to learn one lesson from what has happened in recent years, we deal much more quickly with failing hospitals, and that applies to South London Healthcare NHS Trust as well. Governments and the NHS must never again sit on coasting or failing hospitals for year after year without doing what it takes to sort them out. That is why this year, for the first time, we have put 13 hospitals into special measures. How utterly inexplicable but sadly predictable it is that the Labour party, which failed to sort out those problems, is today refusing to back the changes that mean those mistakes can never be repeated.

Another lesson from the Francis inquiry is that we need to create a culture of openness in health and social care so that, rather than being bullied and intimidated, doctors and nurses feel they can speak out about problems. The Care Bill will introduce a duty of candour as a requirement for registering with a CQC. That means that honesty and openness must come as standard for every organisation. We are also introducing a new criminal offence that will apply to care providers that supply or publish false or misleading information. Directors and other senior staff involved in committing the offence will be held to account. In addition to the Bill, the professional regulators have agreed to place a new strengthened professional duty of candour on all doctors and nurses. The Government are on the side of openness and transparency in our health care system.

--- Later in debate ---

[Andy Burnham]

I will make some progress and turn to part 2 of the Bill and measures related to the NHS. It would help to get a few facts clear. The Secretary of State seeks to denigrate Labour’s record at every opportunity, but let me remind him that the Labour party left an NHS rebuilt with the lowest ever waiting lists and highest ever public satisfaction. The previous Labour Government introduced independent regulation of NHS hospitals for the first time, prompted by previous scandals at Bristol, Alder Hey and the Shipman murders. The Secretary of State should cast his mind back a little further before coming to the House and making unfounded allegations.

As Robert Francis rightly acknowledged in his report, there was no system of independent regulation before 1997. It was the independent regulator that first uncovered the failings at Mid Staffs and, later, at Basildon. As the party that introduced independent regulation in the NHS, Labour has no problem with strengthening it and providing legislative backing for the appointment of chief inspectors for hospitals, general practice and social care, but let us be clear: those were not recommendations of the Francis report.

The Secretary of State accused us of not supporting the Francis report. We do support the report; it is the Government who are not implementing its recommendations. Just as part 1 of the Bill fails to implement the Dilnot report, part 2 fails to implement the Francis report. One of the report’s central recommendations was for a statutory duty of candour for individuals, but the Government are proposing that it should apply only to organisations. How will an organisational duty help individuals to challenge an organisation where there is a dysfunctional culture? It will not, and we urge Ministers to think again. They also need to clarify whether the duty will cover the most serious incidents, and whether it will apply to all organisations that provide NHS services, including outsourced services.

My main objection to part 2, however, is that it embodies the huge contradiction that now sits at the heart of Government health policy. The Secretary of State talks of independence for the Care Quality Commission in the same way as the Health and Social Care Act supposedly legislated for the independence of the NHS, but this is the Secretary of State who has taken to ringing up hospital chief executives who are not meeting their A and E targets. The Secretary of State nods, but that is not “independence of the NHS”. This is the Secretary of State who holds weekly meetings with the supposedly independent CQC, Monitor and NHS England. What precisely is the Government’s policy on independence? People are becoming confused. Clause 118 makes it clear that the Secretary of State wants more control: he wants sweeping powers to close hospitals without proper consultation and clinical support.

[Dame Joan Ruddock]

Does my right hon. Friend recall that in the case of the failing South London Healthcare NHS Trust, the trust special administrator got his financial projections wrong? He massively overspent his own budget, and failed to point out the consequences for the solvent Lewisham hospital, which was in a different trust and which, as a result, did not consult on them. Does my right hon. Friend imagine that there is any way in which such a consultation could take place and produce good outcomes in just 100 days?

[Andy Burnham]

I pay tribute to my right hon. Friend. She and the people of her community stood up to an arrogant Government, and won a victory for every community that was worried about the future of its hospital. One would have thought that, following humiliation in the courts, the Government would have backed off gracefully, but no: here comes the Secretary of State again today, like someone who, having been caught breaking in through the back door, has the brass neck to return and try to force his way in through the front. Well, we will not let him get away with it. We give him notice that clause 118 is wrong, that it is an affront to democracy, and that we will oppose it every step of the way.

Hospital reconfiguration should always be driven by a clinical case first and foremost, but clause 118 paves the way for a new round of financially driven closures. It rips up established rules of consultation and the clinical case for change. It allows the Secretary of State to reconfigure services across an entire region for financial reasons alone, which means that no hospital, however successful, is safe. The House needs to stand up to this audacious power grab by the Executive.