Accountability and Transparency in the NHS

Lord Soames of Fletching Excerpts

Thursday 14th March 2013 Commons Chamber

[Andy Burnham]

I will make some progress.

The first point is about implementation. I would like to take this opportunity to thank Robert Francis for his work on this inquiry and the previous inquiry, which I commissioned. Robert Francis has taken the best part of three years to consider these matters in detail and has made 290 measured and proportionate recommendations. The people affected by these events should reasonably be able to expect that they will be implemented without delay.

I make a genuine offer today to the Secretary of State. If he brings forward proposals, he will have our support in speeding up implementation. I say that because I am becoming concerned about the timetable for the Government’s response. On 6 February, the Prime Minister told this House:

“We will study every one of the 290 recommendations in today’s report and we will respond in detail next month”.—[Official Report, 6 February 2013; Vol. 558, c. 281.]

Since then, the Government have commissioned a review of the recommendations, which is due to report in July. Although, like the hon. Member for Bristol North West (Charlotte Leslie), I have great respect for Don Berwick, I am surprised that the response to a long public inquiry is to set up another review. Is it still the Government’s intention to respond in detail this month? Although I welcome this debate, it is narrow in focus, so will the Secretary of State consider having a full day’s debate in Government time? Instead of more delays and reviews, we need action and a timetable for implementation. I would be grateful if the Secretary of State would respond to my offer today.

[Nicholas Soames (Mid Sussex) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I am making some progress.

The second area where more transparency and accountability is urgently needed is on staffing levels. If the Government are not yet able to commit to all the recommendations, I ask them to expedite their response to Robert Francis’s important recommendation on patient-staff ratios. The board of Mid Staffs embarked on a dangerous programme of staff cuts, and yet public and staff representatives had no outside guidance to challenge it. The chief nursing officer said yesterday that staffing should be a local decision. Surely the lesson of Mid Staffs is that there is a need for much clearer national standards and guidelines, as suggested by the Francis report?

This week, the Care Quality Commission reported that one in 10 hospitals in England and, worse, one in five learning disability and mental health services do not have adequate staffing levels. Surely that should ring alarm bells in the Department as it suggests that parts of the NHS are already forgetting the lessons of the recent past.

The third area on which we need a clear statement from the Government today is the accountability and transparency of all organisations providing NHS services. Under “any qualified provider”, the Government are persisting with their assumption that all NHS contracts should be open to full competitive tender. Despite a promise to rewrite the section 75 regulations that are being made under the 2012 Act, my reading of the rewritten regulations is that regulation 5 will not let doctors decide, but will in effect force clinical commissioning groups to open tender for contracts. That raises the prospect that there will be a significant increase in the coming years in the number of private and voluntary sector organisations providing NHS services.

If we believe in transparency and accountability, surely they have to apply across the board and on a level playing field. The problem is that private and voluntary sector organisations are not subject to the same strictures on freedom of information and whistleblowing. If action is not taken, we face the prospect of a serious reduction in transparency and accountability. Our attempts to find out new information under FOI requests on providers selected under AQP have hit the brick wall of “commercial confidentiality”. I say to the Secretary of State that that is not good enough. Accountability and transparency must always be paramount, as the motion says.

Will the Secretary of State require all providers of NHS services to adhere to FOI principles, and will he ensure that whistleblowers working in organisations that provide NHS services have the legal protections that he has announced today? I draw the attention of the Secretary of State to an early-day motion tabled by my hon. Friend the Member for Easington (Grahame M. Morris) on this subject, which has attracted the support of 109 Members.

The fourth area on which the people of Stafford need openness and transparency is the future of their hospital. They will understandably be worried about the recent recommendation from Monitor that the trust should be placed into administration. People will recall, as I said to the hon. Member for Stone (Mr Cash) a moment ago, that I commissioned Robert Francis in July 2009 to conduct an independent inquiry. I know that many people, including the hon. Gentleman, wanted me to go further and order a full public inquiry, but I stopped short because I was concerned about the effect that that would have on the hospital and its viability.

All of us in this House now have a responsibility to help this hospital heal. After all that they have been through, it would be highly unfair to the people of Stafford if, at the end of all this, they were to lose their hospital or their A and E. They deserve a safe and sustainable hospital and I hope that the Secretary of State’s response to Monitor’s recommendation will map out a way to achieve that.

--- Later in debate ---

[Mr Hunt]

I obviously take on board what my hon. Friend says, but I want to move on to other aspects of the report.

[Nicholas Soames]

rose—

[Mr Hunt]

I shall give way on that point, and then I will make some progress.

[Nicholas Soames]

I am grateful to the Secretary of State. May I follow up on one point that he raised? He said that a number of those managers have disappeared or melted away to other jobs in the service. Does he agree that whatever else happened, there was a monumental failure of leadership at many levels, and that it is a failing of public services in this country—and the national health service in particular—that failing managers are too often recycled through the service to the great and constant cost of patient care?

[Mr Hunt]

I absolutely agree with my right hon. Friend. We will respond to the Francis report this month, as the Prime Minister has committed to do, and make plain measures to ensure that the situation cannot continue. My right hon. Friend is right to raise that point.