Mid Staffordshire Foundation Trust Inquiry

Lord Hunt of Kings Heath Excerpts

Wednesday 6th February 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I thank the noble Lord the Leader of the House for repeating the Prime Minister’s Statement and also for the tone that he has adopted in repeating the Statement. I remind the House of my health interest in the register.

The NHS represents the best values of this country, but what happened at Stafford was an appalling betrayal of those values. We all place trust in the National Health Service. We expect hospitals to be places of the utmost compassion and the highest standards of care. However, at Stafford patients became victims, left lying in soiled sheets, with untreated bedsores, desperately calling for help, but with no response. Relatives who pleaded for assistance were ignored or even made to feel intimidated. I join the noble Lord the Leader of the House in paying tribute to all those former patients, relatives and staff who came forward to speak out, including those who gave evidence to this and to previous inquiries. I also thank Robert Francis for his work on this and his previous inquiry.

What happened at Stafford was not typical of the NHS. Day in, day out, the vast majority of those who work in the NHS deliver great care to patients up and down the country. They are as horrified at all of this as we are. When the first investigation laid bare the facts in 2009, the then Prime Minister apologised on behalf of the Government and the NHS to the patients and families who suffered so badly at Stafford hospital. He was right to do so. I reaffirm that today and our thoughts are with all the victims and their families. What happened has no place in any NHS hospital. We must ensure that it does not and cannot happen again.

Today’s report makes clear that primary responsibility for what happened lay with the board of the hospital. However, there are wider lessons that politicians on all sides must learn, including a lesson for all parties about the dangers of frequent reorganisations of the NHS.

I should like to ask the noble Lord the Leader of the House some specific questions. First, regarding the voice of the patients, effective regulation is essential, but regulators cannot be everywhere, spotting every problem. Patients, their families and staff are everywhere, so we must ensure that they are properly heard. The challenge is to change the culture of the NHS and to support rather than to shut out people who complain. The NHS constitution offers protection for whistleblowers and we support moves to strengthen that. However, the report also highlights criticisms and concerns about both previous and current arrangements for patient bodies. Does the noble Lord agree that, whatever bodies we choose to represent patients, they need to be independent and to have the powers to be an effective voice and challenge to the system. I am sure the noble Lord will have had reported to him last night’s debate on the regulations in relation to local Healthwatch and concern that, as they were drafted, they restrict the activity of local Healthwatch to campaign. I wonder whether, as part of the consideration of the recommendations of the Francis review, the Government would agree to look at the remit and powers of local Healthwatch in order that we might consider strengthening them.

I move to the question of staffing. The basic requirements of any NHS hospital are that there are sufficient staff to look after patients and that they act with compassion. In too many cases at Stafford, this did not happen. Compassion should always be at the heart of nursing, and it needs to be at the heart of nurse training. We support moves to make this more central to nurse training. As Robert Francis has previously said in explaining what went wrong,

“the overwhelmingly prevalent factors were a lack of staff, both in terms of absolute numbers and appropriate skills”.

Does the noble Lord accept the report’s point that we need to consider benchmarks on staff numbers and skills? Can the noble Lord comment on any resource implications that follow from such agreement? Noble Lords will be aware that many NHS trusts are facing severe financial challenges at the moment. Do the Government consider that the NHS has enough resources to ensure that it has the right number of staff in place? This morning the Prime Minister assured the other place that funding is there, but I wonder whether we can be so confident.

My third question relates to regulation. The problems at Stafford should have been picked up much earlier. Monitor and the Healthcare Commission should have worked together much more closely. The Francis report recommends that the two should come together or evolve into a merger. I was rather surprised to read on the Health Service Journal webpage tonight that the Secretary of State has already rejected this recommendation. I was very surprised because in the Statement that the noble Lord has just repeated he said that every recommendation would be studied fully. Can he confirm whether a decision has been made that a merger of Monitor and CQC will not take place? That is a very important matter.

In his Statement the Prime Minister also said that a chief inspector of hospitals would be appointed in the autumn. Can the noble Lord confirm that legislation would be required for that, or is there to be an instruction to CQC to make such an appointment? Is it intended that the remit of the chief inspector of hospitals should cover other parts of the National Health Service? Will there be a chief inspector of primary care? Will there be a chief inspector of social care? Is it intended that the chief inspector will become in effect the boss of CQC, or is this to be a separate appointment? If it is to be a separate appointment, will this person hold independent office, or will he or she be part of the managerial hierarchy of CQC?

Robert Francis rightfully made a great deal of the importance of patient safety. He also referred to the functions of the former National Patient Safety Agency with regard to incident reporting. He said:

“More could be made of this important source of information”.

The noble Lord will be aware that the Health and Social Care Act abolished the National Patient Safety Agency. As part of their consideration of the recommendations of Francis, I ask that the Government consider re-establishing the National Patient Safety Agency as a wholly independent organisation.

I come to the question of healthcare assistants, who do so much important work in our hospital wards and communities. Does the noble Lord agree that we need training and registration to improve standards and safety? In paragraph 1.194 of the summary of Robert Francis’s findings, he makes the point that,

“healthcare support workers … are not subject to any system of registration”.

He says firmly:

“A registration system should be created under which no unregistered person should be permitted to provide for reward direct physical care to patients currently under the care and treatment of a registered nurse or a registered doctor or who are dependent on such care by reason of disability or infirmity in any hospital or care home setting”.

I am sure the noble Lord will have been briefed that in our debates on the Health and Social Care Bill as it went through your Lordships’ House we argued strongly for there to be regulation of healthcare assistants. The Government resisted that. In their consideration of the Francis inquiry recommendations, will they now give sympathetic consideration to the registration of healthcare workers?

I come to my fourth question, which concerns foundation trusts. I am the chair of a foundation trust. I am enthusiastic for them, as I think are many noble Lords on both sides of the House. The journey to foundation status has been a beneficial process for many trusts, but in the case of Stafford it was not. Has the noble Lord made any reassessment of the current timetable for a trust to achieve foundation status and whether more flexibility is needed? Can he assure me that no pressure will be put on the NHS Trust Development Authority to speed up the authorisation of foundation trusts?

The original government intention was for all NHS trusts to become foundation trusts by 2014. I understand that that has slipped. I should be grateful if the noble Lord would confirm that the essential requirement is that a trust is ready to become a foundation trust, not having to fit a timetable that would lead to the kind of pressures that the Mid Staffordshire trust clearly felt itself under.

That brings me to targets. It was suggested, in the briefing before the report was published, that targets themselves were to blame. However, today’s report does not support that. It says that,

“it is not suggested that properly designed targets, appropriately monitored, cannot provide considerable benefit to patients”.

Does the noble Lord accept, as Francis’s analysis suggests, that the problem at Stafford was how the A&E target was managed by the hospital, and that many hospitals up and down the country have delivered excellent care while meeting the accident and emergency target? We must never go back to the bad old days when people were left waiting for hours on trolleys and 18 months for an operation.

I turn to integration. The ageing society is bringing a whole new set of demands on to the NHS: a group of elderly and infirm patients who require not just physical treatment for their immediate illness but much greater care and attention for their basic needs. As Francis says, we must address this new challenge that the NHS faces and ensure that we avoid a repeat of what happened at Stafford. Does the noble Lord agree that in every hospital we need to put in place the right support for the whole of a person’s needs, including for our elderly population? Does he agree that that means breaking down the barriers between healthcare and social care? Does he also agree that the cultural change that the Prime Minister referred to in relation to hospitals applies as much to community, primary and social care?

The number of noble Lords who are here at this time of night to listen to the Statement indicates that many noble Lords have a great deal of interest in this. I ask the noble Lord to pursue through the usual channels the opportunity for an early and lengthy debate on the Francis report. That would be very much appreciated by noble Lords.

We cannot turn back the clock and undo the damage at Stafford but we owe it to those who have suffered, to the people of Stafford and to the country as a whole to work together to act on this report and prevent a scandal like this from happening elsewhere. We on this side of the House will play our part in making that happen.