Francis Report

Debate between Kevin Barron and Baroness Keeley

Wednesday 5th March 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I reread the executive summary of the Francis report yesterday when I was on a train journey, and I decided that in today’s debate I would like to look at one of the most crucial aspects of his findings in respect of what happened at Mid Staffs.

On page 62, at paragraph 1.102, the summary states:

“The senior officials in the DH have accepted it has responsibility for the stewardship of the NHS and in that sense that it bears some responsibility for the failure of the healthcare system to detect and prevent the deficiencies at Mid Staffordshire sooner than it did. There is no doubt about the authenticity of their expressions of shock at the appalling story that has emerged from Mid Staffordshire. However, it is not possible to avoid the impression that it lacks a sufficient unifying theme and direction, with regard to patient safety, to move forward from this point in spite of the recent reforms put in place by the current Government.”

It goes on to say:

“Where there are perceived deficiencies, it is tempting to change the system rather than to analyse what needs to change, whether it be leadership, personnel, a definition of standards or, most importantly, culture. System or structural change is not only destabilising but it can be counterproductive in giving the appearance of addressing concerns rapidly while in fact doing nothing about the really difficult issues which will require long-term consistent management. While the DH asserted the importance of quality of care and patient safety in its documentation and its policies, it failed to recognise that the structural reorganisations imposed upon trusts, PCTs and SHAs implementing such policy have on occasion made such a focus very difficult in practice.”

It is my contention that we could probably say that of every reorganisation of the NHS, certainly in my three decades in politics.

The summary goes on to discuss the lessons learned and related key recommendations:

“The negative aspects of culture in the system were identified as including: a lack of openness to criticism; a lack of consideration for patients; defensiveness; looking inwards not outwards; secrecy; misplaced assumptions about the judgements and actions of others; an acceptance of poor standards; a failure to put the patient first in everything that is done.”

It goes on:

“It cannot be suggested that all these characteristics are present everywhere in the system all of the time, far from it, but their existence anywhere means that there is an insufficiently shared positive culture.”

Again, it is my contention that that sums up not just the past 30 years but perhaps the past 60 years of our national health service.

The summary goes on to say that achieving change

“does not require radical reorganisation but re-emphasis of what is truly important”.

All parties in the House should recognise that it is not the reorganisation but the re-emphasis of what is important that is significant. Paragraph 1.119 lists how that can be achieved:

“Emphasis on and commitment to common values throughout the system by all within it; readily accessible fundamental standards and means of compliance; no tolerance of non compliance and the rigorous policing of fundamental standards; openness, transparency and candour in all the system’s business; strong leadership in nursing and other professional values; strong support for leadership roles; a level playing field for accountability; information accessible and useable by all allowing effective comparison of performance by individuals, services and organisation.”

I was not surprised by any of that.

The right hon. Member for Sutton and Cheam (Paul Burstow) was a member of the Select Committee on Health in the previous Parliament between 2005 and 2010, and I had the privilege of chairing that Committee. In 2009 the Committee looked at patient safety in the NHS. We visited one of only four hospitals that were part of a patient safety project on how to look after patients inside hospitals, never mind outside. We looked at some of the major issues at the time, such as how different parts of the NHS interacted and their failure to communicate with one another properly. Much of the time they were working with different regulations, and occasionally the inspectorate was not sure what it was responsible for inspecting. This whole restructuring has been going on for a very long time, and it has been more confusing to people working inside.

I am pleased with how the Government have reacted to some of the Francis report’s main recommendations, but I take issue with them on one point. If we are to change the culture inside the NHS, we really need to look at the duty of candour. The Government have accepted the report’s recommendation on a duty of candour for organisations, but they have rejected the recommendation to extend that duty to individuals. I think that is fundamentally wrong.

I spent nine years as a lay member of the General Medical Council, which regulates doctors, and for the first few years I would sit on fitness-to-practise committees. I think that the only way we shall get change is if individuals have responsibility for the duty of candour, not just organisations. I believe that the Government have got that fundamentally wrong. If they really want to tackle the issues that led to the awful situation at Mid Staffs, they need that duty of candour to extend to individuals.

On the Government’s decision on the duty of candour, the Patients Association has stated:

“We question that if individuals are not already motivated by their own professional code, how will a duty on their employer encourage them to come forward?”

That is absolutely right. It continued:

“Without this fundamental change within the NHS, the Duty will just be providing lip service to the issue of patient safety and patients will struggle to see any real improvements.”

That is a big assumption, but on balance I agree. It is something that the Government, no matter who is in Richmond House, need to tackle throughout the NHS.

I have in my hand a copy of the Health Committee’s report on patient safety, which was published in July 2009. We looked at patient safety across the health care system and compared it with what was happening abroad. We visited New Zealand, which has a comparable health system—I accept that the country has only 4 million occupants, compared with our 60-odd million. We looked at why the culture here is the way it is, why people are not open and why they do not learn from mistakes that other health professionals have made. Often those mistakes are not reported because people fear they will get into trouble. We took evidence from the British Airline Pilots Association and learned that any mistake a pilot makes in an aeroplane is whizzed around the world so that other pilots understand it and learn the lessons immediately. That is not the case in our health service.

I want to mention two of the Committee’s findings from New Zealand. The first relates to investigating complaints. I do not think that leaving the duty of candour to organisations, as the Government suggest, will work well. New Zealand has a statutory body—I have mentioned it before in the House—called the Health and Disability Commissioner, which resolves complaints. People can go to the commissioner to request investigations, and they can do so anonymously if they do not want their colleagues to know about it. It is completely independent of the health care system. It works, and it has been working for many decades.

Another area we looked at in New Zealand—again, I accept that it is a very small country—was compensation and redress. I know from my experience of 30 years in Parliament that when people complain about something that happened to them in their local hospital that they are unhappy about, they are treated as if they are going to get into litigation and that it will cost a lot of money; immediately the barriers come up. That culture is not good for our health service, it is costing massive amounts of money for us as taxpayers, and it is certainly not good for the individual concerned. I do not know how many times I have been told that all the patient wanted was an admission that the hospital got it wrong and an apology; they did not necessarily want money. New Zealand has a redress system that some might call a no-fault liability system. Here, it would mean getting rid of lots of lawyers who make massive amounts of money and careers from public money for NHS litigation. Just those two areas hold back changing what is wrong in our system.

[Barbara Keeley]

I wonder whether my right hon. Friend has had similar cases to a difficult one that I had for months involving someone whose wife died in terrible circumstances at home. He was badly let down by the care she received and he wanted redress. He found that people were happy to have meetings with him and to talk to him, and were sympathetic and supportive, but whenever something was put in writing, it was absolutely dreadful. He was very offended and horrified by everything that was in writing, and that is the chilling effect of lawyers because they checked everything. It ruins the support that can be given after a difficult bereavement and when someone has a real case. Things can be said, but they cannot be written down.

[Kevin Barron]

I agree entirely. The system is defensive and people do not get a satisfactory response, but the lessons are not learned. Issues are not reported for fear of the consequences. The Minister is a doctor. He will know that if as a junior doctor he had seen a senior doctor doing something wrong and had gone public about it, it might have affected his career. Some young doctors’ careers have been affected. That is not good for the system, and it is certainly not good for patients.

I am a wholehearted supporter of the national health service and the way it is funded. There is none better in the world, and we can use it without question. It may be different in different parts of the country, but access to health care in this country is second to none in the world for the whole population as opposed to just those with money. Could it better? Yes, and what the Francis report said was a lesson for all of us, and for the national health service. We should change the culture, but we will not do that with reorganisation or by blaming one another in the Chamber for what is right or wrong. That just feeds the politics of the national health service. We must change the culture by putting the patient first, and after 60-odd years it is about time we did.

Tobacco Packaging

Debate between Kevin Barron and Baroness Keeley

Thursday 7th November 2013 Commons Chamber

[Mr Barron]

It is indeed. The packages themselves are there to attract young women. I have an empty packet in my office that demonstrates exactly that. The idea that packaging is not used to sell products or advertise them effectively is nonsense. The Silver Slide design is intended deliberately to undercut the health warnings that the law now requires on each packet.

The hon. Member for Ribble Valley talked about adverts and bill posters, and said that he could only understand the part at the bottom. When I introduced a private Member’s Bill in 1994 to get rid of tobacco advertising and promotion, it was pretty clear that most of the adverts on billboards were not understood by some people. They were deliberately designed for the inquiring mind. There would be a picture of a piece of silk with a cut halfway down the middle. The advert did not say Silk Cut cigarettes; it did not have to. However, who are the ones with inquiring minds? They are young people. Tobacco companies did that deliberately for many years, and the G. K. Chesterton quote is to get young people to say that they can take this on, and that they are not bothered about what people say.

In Australia, it has been decided that there should be no branding on tobacco packaging other than the product name shown in a standard font, size and colour. No other trade marks, logos, colour schemes and graphics are permitted. Colours and graphics have been selling cigarettes in this country for decades. In Australia, cigarette packs should not carry attractive designs and should therefore come in standard shape, size and colours, and the colours should be as unattractive as possible. There should be prominent health warnings front and back, in pictures as well as writing, and there should be a phone number and web address on every pack to help smokers to access quit services.

There are 100,000 premature deaths a year from tobacco smoking in this country. If those deaths had been caused by anything else in the 30 years that I have been in Parliament, this House would have been sitting 24 hours a day, seven days a week, until we could find a way to stop it. It is no good the Government saying that they will wait. We know what tobacco marketing has been like for decades. We have stopped most of it, and we should stop this advertising at the point of use as well.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

In an area such as Salford, 1,000 young people—the figure was 1,100 in Barnsley—will start to smoke this year. If I am called to make a speech, I will talk about that. Ten months, a year or 18 months of delay will cause 1,000 or 1,500 young people in an area such as mine to start smoking, and that is a tragedy.

[Mr Barron]

And another 207,000 nationally will start this habit a year.

One might ask why people buy a packet of cigarettes when it has a warning on it, but this is an addiction. All sorts of addictions sadly roll over common sense, and tobacco is no different. Stopping young people starting is crucial, and that is working. Smoking rates for young children are diminishing now, as are rates for adults, partly as a result of taxation and partly because we are stopping tobacco companies promoting cigarettes.

There are no figures to show that counterfeiting is more likely with plain packaging. Earlier this year, the Japanese company came to the House and told us that there would be more counterfeiting, but there is no evidence of that. It showed us—I have one in my pocket —a counterfeit packet. It looks like any other Benson & Hedges packet, so counterfeiting happens now. Standard packaging could include features to protect against counterfeiting, and it is for the House to regulate to introduce them. Hon. Members should not use the arguments that have been sold by the tobacco companies year after year. When it was found that tobacco related to massive numbers of deaths, the companies were still questioning that decades after the event—they still do now. They use this House to do it on occasions and, I have to say, it is wrong. When there are 100,000 premature deaths a year, we as legislators have some responsibility to alleviate the problem. I know that smoking is addictive and it is difficult for people to stop.