Mid Staffordshire Foundation Trust Inquiry

Lord Hunt of Kings Heath Excerpts

Tuesday 26th March 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I am sure that the House will wish to thank the noble Earl for repeating the Statement.

The NHS is now 65 years old and if it is to be ready for the challenges of the future it has to learn from what happened at Mid Staffordshire. The NHS was founded on compassion; Mid Staffordshire was a betrayal of all it stands for and, rightly, apologies have been made. Now, however, it is time to act and to make this a moment of change. Robert Francis delivered 290 careful recommendations after a three-year public inquiry. The Prime Minister promised a detailed response to each by the end of this month. Although we welcome much of what the noble Earl has said today, it falls short of that promised full response. I ask him to be a little more precise about when we can expect the full response to be made.

There are serious omissions from the Statement on four flagship recommendations and I would like to press the noble Earl on those today. First, I should like to deal with the proposed duty of candour. We from the Opposition welcome the move to place a duty of candour responsibility on healthcare providers and believe that it could help bring the culture change that the NHS needs. However, the noble Earl will know that the Francis report goes further in recommending a duty of candour on individual members of staff. Will the Secretary of State say more about why he has only accepted this recommendation in part and not applied it to staff? Has the noble Earl ruled this out, or is he prepared to give further consideration to it?

On providers, will the noble Earl assure the House that that duty will apply equally to all providers of NHS services, including private providers? The Statement was rather vague on that point. The logic of a fair playing field, which I think has been the subject of a report published today, must suggest that anyone providing services to the NHS must come within the same regulation. I refer the noble Earl to the experience in Cornwall where there is a private sector provider and a weak primary care trust which the National Audit Office has commented on. Would that provider come within the terms of what the noble Earl has said?

I was interested in the Statement referring to new legal sanctions in general at a corporate level for organisations that wilfully generate misleading information or withhold information they are required to provide. Can the noble Earl confirm that that sanction will apply to Ministers, the Department of Health, the NHS Commissioning Board, Monitor, the CQC and all the other public regulators and those who have authority over the NHS? It would be grossly unfair if this was simply to apply to parts of the National Health Service and not to those organisations that have so much power over the NHS. I would be grateful for a response on that.

I turn to the other issue in relation to private providers. Is it not the case that we will not get full transparency unless provisions of freedom of information apply to all holders of NHS contracts and the information cannot be withheld under commercial confidentiality? I remind the noble Earl of the regulations in relation to Section 75, which are absolutely apposite to this question of a level playing field.

I turn to the question of a patient voice. The Government have announced new chief inspectors of hospitals and social care, which was not a Francis recommendation. Is there not a risk of top-down regulatory structures reinforcing the wrong culture, looking up to Whitehall and not out to patients and the community? Surely the noble Earl will accept that regulation alone will definitely not prevent another Mid Staffs. What might prevent it is a powerful patient voice in every community that is able to sound the alarm if things go wrong. In that context, I have a question about local Healthwatch? We know that one-third of local authorities have said that their local Healthwatch will not be up and running by 1 April. We also know that there are wide variations in structure and membership. I wonder whether the noble Earl will accept Robert Francis’s recommendation of a consistent basic structure for Healthwatch throughout the country, before it is too late and before they go their separate ways. The importance of the proposal is that these bodies can give a very powerful voice to patient concerns about the quality of care in their locality.

My third area of concern is regulation and training. Mr Francis has made a very clear case for a new system of regulation of healthcare assistants to improve basic standards. The noble Earl does not need reminding that many noble Lords are concerned on this point. Unfortunately, I did not hear in his reading of the Statement any reference to the statutory regulation of healthcare assistants, and it is disappointing that the terms of reference for the Cavendish review do not include consideration of that matter. Have the Government now rejected that recommendation; are they still considering the regulation of healthcare assistants; or have they decided after all to support the principle?

We support the move to rebalance nurse training to include more hands-on experience. Does the noble Earl accept that hospitals need to be given much more authority in the training of nurses and the balance between what happens in hospitals and what actually happens within universities? Does he acknowledge that student nurses already spend 50% of their time in clinical practice and also face significant financial barriers when completing training? In the light of the announcement, can he assure the House that the requirement for a year on the ward will not increase the financial barriers to young people entering nursing? If more trainees are to be on the ward, will he ensure that there are enough staff with the time to train the extra students? In that light, will the Government encourage the appointment of supervisory ward sisters to allow more time for leadership, training and support of those student nurses? I should have declared an interest in making this response to the Statement. The noble Earl will be interested that my own trust, Heart of England, has announced this week a £1.4 million investment in the introduction of supervisory ward sisters to do just that. Will he encourage other hospitals to do likewise?

I listened with care to the Statement when it referred to the creation of a culture of zero harm throughout the NHS. Such an objective must be right. We know from previous statements that the Secretary of State is keen to follow the example of the airline industry and note that Professor Don Berwick will report to the Secretary of State on those matters. However, does the noble Earl not think it rather ironic that the Government abolished the National Patient Safety Agency, which was set up to mirror what has happened in the airline industry and encourage staff to raise concerns about patient experiences? Does he not see that although the national reporting and learning system has been retained, placing it under the control of the NHS Commissioning Board is completely at variance with the philosophy in the airline industry of giving people absolute safety in reporting incidents to the system? Will the noble Earl reconsider this matter?

I have real concerns about the decision that the CQC will no longer be responsible for putting right any problems with quality identified in hospitals. I do not think that that is the right decision. How on earth can the decision be taken to give Monitor and the NHS Trust Development Authority—which, as far as I know, has no clinical expertise whatever—the power to deal with issues which the CQC has raised? Other than the thought that they are relying on health and competition economists—which Monitor is stuffed full of—to do this, does it mean that Monitor will now have to employ lots of clinicians on its staff? Can the noble Earl explain why this rather puzzling decision has been made?

The fourth major issue concerns staffing, which is the most glaring omission from the Statement. The culture will never be right on our wards if they are understaffed and overstretched. The CQC has recently reported that one in 10 hospitals does not have adequate staffing levels. Indeed, last week, workforce figures showed that there had been a reduction of 843 nurses between November and December. Does this not sound the clearest of alarm bells that some parts of the NHS are in danger of forgetting the lessons of its recent past by cutting the front line? Do we not need objective benchmarks so that staffing levels can be challenged on wards?

Last week, we learnt that the Department of Health has handed £2.2 billion from last year’s NHS budget back to the Treasury. Would not that money be better used to bring nursing staffing levels up to standard? I wonder whether the noble Earl and his ministerial colleagues are in denial about the pressures on the health service at the moment. The system is under horrendous pressure. Primary care is faltering. We heard earlier about the appalling standards in many out-of-hours services at the moment. The 111 service is problematic in some parts of the country. There have been huge cuts in local government adult social care spending. Yet the system—Monitor and the NHS Commissioning Board—carry on oblivious to this, obsessed by their target culture. I ask the noble Earl whether Ministers really understand what is happening, and whether they are now prepared to look again at the way the system will be managed in the future.

Finally, I return to Mid Staffordshire hospital itself. Monitor has recommended that this hospital is placed in administration. We should not forget that the future of the hospital will cause real concern to the people of Stafford. After all they have been through, surely we can all agree that they deserve a safe and sustainable hospital. I hope that the noble Earl will soon be able to set out a plan to achieve it.