Managing Risk in the NHS

Liz Kendall Excerpts

Wednesday 17th July 2013 Commons Chamber

[Mr Hunt]

My right hon. Friend makes an important point. There are many locums who work extremely hard and are very committed. However, it is true that one feature of a number of the failing hospitals in yesterday’s report was that they had a high proportion of locum staff. It is harder to build up a sense of teamwork if there is a huge turnover in the people working in NHS organisations, and I know that many will reflect on that.

[Liz Kendall (Leicester West) (Lab)]

Will the right hon. Gentleman give way?

[John Pugh (Southport) (LD)]

Will the right hon. Gentleman give way?

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Walsall South (Valerie Vaz) in this important debate. As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) and my hon. Friend the Member for Halton (Derek Twigg) said, over the past three years the biggest risk to NHS patients and taxpayers has been this Government’s decision to force through the largest back-room reorganisation in the NHS’s history at the same time it faces the biggest financial challenge of its life.

We left government with the lowest ever waiting lists and the highest ever patient satisfaction, but we knew that further changes were essential to improving the safety and quality of patient care and getting better value for taxpayers’ money. And we had a plan to make it happen in every region in England, through Lord Darzi’s report, “High Quality Care for all”, which set out precisely how we would achieve the kind of reconfigurations of hospitals that the hon. Member for Bracknell (Dr Lee) mentioned and precisely the kind of integrated services focused on prevention in the community mentioned by my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Walsall South. But Ministers scrapped those plans and instead forced through a top-down reorganisation that not only wasted billions of pounds, but meant that local services lost grip and focus precisely when they were needed most.

The Government were repeatedly warned about the risks of their Health and Social Care Bill. While they have refused to publish their own national risk register, up and down the country local NHS organisations did the job for them. Those local NHS risk registers warned that front-line staff would be cut. They were right: over 4,000 nursing posts have been lost under this Government. They warned that specialist cancer networks would be scrapped, and they have, along with Labour’s stroke networks, both of which were vital to improving the quality of patient care. The local risk registers also warned that structural upheaval and fewer front-line staff would destabilise winter planning and mean more patients waiting longer in A and E. That is precisely what has happened.

This Government have presided over the worst A and E crisis in a decade. At its height, 100 trusts failed to meet the four-hour A and E target. Even during spring, more than half of all hospital trusts missed the target. The risk to patients is not just that they have been left waiting for hours in distress and pain on trolleys or in the back of ambulances. As Sir Bruce Keogh’s excellent review states,

“over 90% of deaths in hospital happen when patients are admitted in an emergency rather than for a planned procedure”.

He goes on to say:

“The performance of the majority of the trusts was much worse than expected for their emergency patients.”

He is right. At the end of last year all 14 of those trusts were missing this Government’s lower A and E target, yet under the previous Government all 14 were meeting our higher A and E target.

Instead of getting to grips with the real causes of the A and E crisis so that they can deliver real solutions for patients, the Government have consistently sought to score political points by blaming the 2004 GP contract. [Interruption.] The Secretary of State says from a sedentary position that that is what the evidence says. Well, NHS England, the NHS Alliance and the NHS Confederation beg to disagree, to name just a few. They say that the real causes are primarily that more very elderly, sick patients are ending up in hospital and getting stuck there because of pressures on social care budgets, and that there are not enough services for specific groups of patients such as those with mental health problems and drug and alcohol addiction.

Ministers’ sheer incompetence in introducing the NHS 111 phone line has compounded the pressures in A and E. They were repeatedly warned, by the Royal College of Nursing, the British Medical Association, the Ambulance Service Network, NHS Direct and potential private providers, about problems with their rushed roll-out, but they ploughed on regardless. The result was patients left hanging on the phone or waiting hours for call-backs, more ambulances being sent, and more patients ending up in already struggling A and Es. A report on this fiasco by the NHS Alliance, which represents primary care providers and commissioners, says that

“providers were put under unprecedented pressure by the Department of Health to meet their go live dates even if...they weren’t prepared”.

They say that the Government’s contracts focused more on cost than quality, yet they have disgracefully ended up failing on both.

We now face the real risk that the Government will fail to put in place many of the key changes that patients and the public desperately need. It is right that the Government are looking at the training of nurses throughout the NHS. I have no doubt that Sir Mike Richards will be an excellent chief inspector of hospitals. However, regulation happens after the event, whereas we need to focus on preventing problems from happening in the first place. That means having clear lines of accountability and responsibility from the bedside to the boardroom. It means listening to patients and the public. It means having a strong voice for local Healthwatch bodies. Hon. Members will know that up and down the country those have been very slow to get up and running and have very few staff. The task put on to them—to make sure that they are a strong voice for patients and the public—will be extremely difficult to carry out.

The Government are missing out on three key issues that have repeatedly come up in this debate. The Keogh review found time and again that staff shortages in the 14 hospitals with higher mortality rates are a real risk to the safety and quality of patient care, as did the Francis inquiry into the appalling failings at Mid Staffs hospital. That is why Francis makes very clear recommendations about staff numbers. The Secretary of State would not take an intervention from me earlier, so I will tell him what I was going to say now. Recommendations 22 and 23 in the Francis report say:

“The National Institute for Health and Clinical Excellence should”

set out

“standard procedures and practice”

and those should include what each service

“is likely to require as a minimum in terms of staff numbers and skill mix. This should include nursing staff on wards, as well as clinical staff.”

The report also says that

“no unregistered person should…provide…direct physical care to patients”

and that this

“should apply to healthcare support workers”.

We tried for many years to improve their training, but without their being registered so that it could be guaranteed that they had the training required, it was not possible to do so. I called for this back in 2001, before I became an MP. The same arguments were being made then. We have not made progress and we need to do so now.

Finally, Francis says there should be a statutory duty of candour on individual registered staff as well as providers, yet the Government are dragging their feet on all those key recommendations. As Peter Walsh, the chief executive of Action against Medical Accidents, said yesterday,

“ministers are still refusing to accept key recommendations such as minimum staffing levels for wards and regulation of healthcare assistants.”

He also said that he hoped that Sir Bruce Keogh’s report will change the Government’s mind, and Opposition Members agree with him.

Government Members have made unfounded accusations that Labour Members covered up problems in the NHS, but our record proves that we did the precise opposite: independent inspection of the NHS for the first time; national data published on heart and stroke care and hip and knee operations for the first time; patient choice of hospital enshrined for the first time; and, far from ignoring mortality rates, it was the Labour Government who published them on the NHS Choices website for the first time.

Government attempts to smear former Ministers are shameful, but the real tragedy is not the cynical, political agenda being pursued by the Conservative party; it is that over the past three years the Government have put the NHS through risks that could have been avoided and they are failing to put in place the real changes and reforms that patients and the public need. I commend the motion to the House.