Francis Report

Mark Harper Excerpts

Wednesday 5th March 2014 Commons Chamber

[Mr Hunt]

As the hon. Gentleman knows, I used to be responsible for sport in this country, so I take a great deal of interest in the issue. I will certainly consider his point. We all remember what happened to Fabrice Muamba, and sport has a role to play in raising awareness of conditions that people might not otherwise be aware of.

[Mr Mark Harper (Forest of Dean) (Con)]

From listening carefully to my right hon. Friend’s remarks, I noticed that he referred to England. I am not sure that all the lessons from the Francis report have necessarily gone across the border to Wales. That concerns me, because thousands of my constituents are forced to use the NHS in Wales—although their GP is in England, they are registered with the NHS in Wales. Can my right hon. Friend say anything to reassure my constituents that they will soon be entitled to treatment in England, as is their legal right?

[Mr Hunt]

I am concerned about that on a number of levels, but I can reassure my hon. Friend that I have taken on board that point, which he has raised with me privately, and I will look into it. I have asked for a solution to be found soon, and certainly before the end of the year, so that his constituents can have that long-standing problem addressed.

Nurses, who were mentioned by the hon. Member for St Ives (Andrew George), have also embraced reform. The inquiry was clear that

“practical hands-on training and experience should be a pre-requisite to entry into the nursing profession”.

We now have 165 nurse trainees spending up to a year as health care assistants before starting a degree—a pilot that will inform how we roll out the programme nationally. The inquiry said the public should always be confident that health care assistants have had the training they need to provide safe care, and on the advice of Camilla Cavendish our new care certificate will provide assurance that health care assistants and social care support workers receive the high-quality, consistent training they need to do their jobs and deliver compassionate care.

Robert Francis also identified particular problems with the leadership of Mid Staffordshire Trust. We have many outstanding leaders in the NHS, but not enough, so we have set up a 50-place fast-track executive programme to attract clinicians and talented outsiders into NHS management, and we have already had more than 1,600 applicants. We are also introducing a new fit and proper persons test for board-level appointments, to help ensure that people with poor track records cannot resurface elsewhere.

The inquiry also heavily criticised my Department for being

“too remote from the reality of the service they oversee”.

We have introduced a new programme, “Connecting”, under which civil servants will spend four weeks every year on the front line. In the past year, Ministers, including me, and senior officials have spent more than 1,300 days working on the front line, leading to what I believe is a real and profound change in the way we approach our work and ensure good advice is provided to Ministers. Those changes have seen a welcome increase in the number of staff who feel that care of patients is the main priority for their organisation, according to the latest NHS staff survey.

If the NHS has listened, so too must we in this House. As constituency MPs, many of us, including me, have championed our local hospitals, sometimes unquestioningly, and sometimes without sufficient regard for the quality of care provided. Too often we have accepted the convenient explanation that individual cases of poor care were the exception, when in our hearts we knew the problem was more widespread. We must be champions for change in our communities, just as the Mid Staffs campaigners were champions for change in theirs.

Nowhere is that more true than in Wales. Although health is a devolved issue, unfortunately failures in care in Wales are now having a direct impact on NHS services in England, with a 10% rise since 2010 in the number of Welsh patients using English A and E departments, leading to very real additional pressure on border town hospitals. What is causing that pressure? Dr Dai Samuel of the Welsh BMA describes standards of care in Wales as follows:

“It’s pretty horrific...the level of care being given to patients is compromised...substandard we are seeing a miniature Mid Staffs every day.”

NHS England medical director professor, Sir Bruce Keogh, and president of the Royal College of Surgeons, Professor Norman Williams, have written to the Welsh authorities calling for action, only to be completely ignored. Professor Williams said that

“an analysis of NHS data in the region has highlighted the fact that the waiting lists for elective cardiac surgery in South Wales are higher than is clinically appropriate... Expert reports suggest that 152 patients have died in the past 5 years while on the waiting lists”.

If that creates pressure in England, it is a tragedy for Wales, yet still the authorities there continue to act as if the lessons of Mid Staffs stop at the border. If the Labour party, which runs the NHS in Wales, will not listen to the Government about this, it should please listen to its own Back-Bencher, the remarkable right hon. Member for Cynon Valley, who, following her own terrible family experience, has campaigned tirelessly to improve standards of care in Wales, particularly with respect to mortality rates at six Welsh hospitals. If there is one outcome from today’s debate, let it be not simply an examination of data methodology in Wales, but a proper, independent examination of mortality rates, allowing UK-wide comparisons. Given the implications for the English NHS, we need leadership from Labour Front Benchers in this place to encourage their Welsh colleagues to do what is right to save lives in Wales, as well as to reduce pressure on the NHS in England.

That highlights a broader, more uncomfortable issue for the House. Clear policy mistakes lay at the heart of why Mid Staffs was ever allowed to happen, but while no one is questioning the integrity or good intentions of Ministers in that period, those mistakes have never been acknowledged by the Labour party, even though the entire tragedy happened on its watch. Labour continues to make a political issue of which party can be “trusted” with the NHS, but cannot see that the refusal—[Interruption.] This is uncomfortable for Labour Members to hear, but lives were lost and I suggest they listen. Refusing to learn the lessons of Mid Staffs is the surest way to persuade the public that Labour does not merit that trust.

Do Labour Members now accept that the Government were right to hold a public inquiry into Mid Staffs, contrary to their wishes, given the many important changes that have come about as a result? Do they accept that Mid Staffs was not just about bad individuals, but about a corporate obsession with system targets that led to poor and unsafe care, and that we must not allow that to happen again? Do they accept that the Government were right to restore expert-led inspections that Labour got rid of 2008, and will they now undertake to support the new chief inspectors in their much more rigorous inspections? Do Labour Members accept that Ministers should never—as was alleged to have happened before—put pressure on regulators to tone down news about poor care? Do they support the statutory independence that we have now granted the CQC? Do they accept that we should never push hospitals to foundation trust status so quickly that they neglect patient care? Finally, and most important, do they accept that exposing and being honest about poor care is not about running down the NHS but is about protecting it and standing up for patients? I hope that when the right hon. Member for Leigh (Andy Burnham) responds he will be able to answer those questions and put to rest the concerns of relatives and survivors of Mid Staffs about his approach to date.

--- Later in debate ---

[Andy Burnham]

That is what I am saying: A and E is the barometer of the whole system. If there is pressure anywhere, in the end it shows up in A and E. Hospitals become jammed: they cannot admit people from A and E to the ward because people in the ward cannot be discharged home. This is what we are seeing. The Secretary of State is in denial, basically. He is shaking his head and saying that this is nothing to do with the issues raised by the Francis report. I am afraid that this is the real experience of people—staff and patients—up and down the country, and the sooner he wakes up to it the better for us all. If he thinks the situation with regard to getting a GP appointment is acceptable at the moment that is up to him, but those of us on the Opposition Benches find it completely unacceptable. It is simply not good enough and the sooner he pulls his finger out and does something about it the better.

The Secretary of State’s failure even to acknowledge these issues today is a matter of some amazement, given that he could find time to talk on an area that is not his responsibility—the NHS in Wales. There are, of course, important issues that the Welsh Assembly needs to address, but voters in England might appreciate it if he spent a bit more time sorting out problems here rather than pointing the finger over there.

[Mr Harper]

The NHS in Wales is relevant. Thousands of constituents in England have to use the NHS in Wales—the point I made to the Secretary of State—because of the Labour party’s ill-thought-out devolution settlement. Thousands of patients in Wales cross the border to use the NHS in England, too. What lessons should this House draw from the Labour party’s performance in running the NHS in Wales, if the shadow Secretary of State is ever back in my right hon. Friend’s chair at the Department of Health?

[Andy Burnham]

I, as part of the previous Government, left the lowest waiting times in the history of the NHS, and A and E was performing much better at the end of the previous Government than it is now. Hospital A and Es have dropped right down, so we do not need to take lessons from the hon. Gentleman.

Let us return to the issue of England and Wales. The mantra or script of Government Members is almost to deny that there are problems in England. Last week, 16 major A and Es in England were below the Welsh average on waits in A and E. Some trusts are seriously struggling, such as in Leicester, in the constituency of my hon. Friend the Member for Leicester West (Liz Kendall), and Great Western Hospitals NHS Trust and North West London Hospitals NHS Trust, where one in four patients were waiting more than four hours.

Another trust below the Welsh average was Barking, Havering and Redbridge, which includes Queen’s hospital, Romford. May I recommend to the Secretary of State that instead of sitting there mumbling away, he read an article on The Guardian website today by Saleyha Ahsan, an A and E consultant who has worked at Queen’s hospital, Romford? She writes:

“Being a doctor in accident and emergency has at times resembled being a medic in a war zone.”

May I remind him that this is the English NHS she is talking about—the one he is supposed to be responsible for? She goes on to say that the severe shortage of A and E doctors is a result of his predecessor’s failure to listen to the warnings from the College of Emergency Medicine about the looming recruitment crisis, because it was obsessed by its reorganisation. Dr Clifford Mann said he felt like

“John the Baptist crying in the wilderness”

because the Government’s reorganisation brought “decision-making paralysis” to the NHS. What does Dr Mann say now? He says that even after the reorganisation these issues cannot be dealt with, because

“there are now a lot of semi-detached organisations to deal with”.

Government Members do not like hearing it, but the fact is that the reorganisation by the right hon. Member for South Cambridgeshire (Mr Lansley) damaged front-line care in the NHS. May I remind the Secretary of State that just 12% of people think standards in the NHS have got better under the coalition, while 47% think they have got worse? Rather than pointing the finger at Wales, the Government need to spend a bit more time sorting out the problems they have created in England.

As my hon. Friend the Member for Easington (Grahame M. Morris) says, an urgent area that needs to be addressed is mental health. Some 1,700 mental health care beds have been cut over the past two years because these Ministers have allowed the first real-terms cut in mental health spending for a decade. As a result, alarming stories are emerging of very vulnerable children and adults being held in inappropriate accommodation, such as police cells. According to Mind, many trusts are reporting more than 100% bed occupancy. One trust in London has had to turn office space into temporary wards with camp beds.

We are also hearing of children being sent hundreds of miles to find an available bed. In a constituency case, my hon. Friend the Member for Leicester West found that there was simply no bed available in the public or private sector anywhere in England on a day when a very vulnerable child needed support. A recent freedom of information request by Community Care found that in 2013-14 10 trusts sent children to young people’s units more than 150 miles away. The furthest distance was 275 miles, from Sussex to Bury. A 12-year-old girl from Hull was sent 130 miles away to a unit in Stafford. Her child and adolescent mental health services team were searching for a bed for two days, and were told that the Stafford bed was the only one available in the country.