Accountability and Transparency in the NHS

Nigel Evans Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Cash]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Please resume your seat, Mr Cash.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Eight Members are trying to catch my eye and we will finish at 5 o’clock, with Charlotte Leslie having the last two minutes. In order to accommodate everybody, as well as interventions, the time limit is now five minutes.

--- Later in debate ---

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am encouraged by the speech from my hon. Friend the Member for South West Bedfordshire (Andrew Selous) because it shows that accountability is not just about supervising organisations, regulators, targets, safeguards, mechanical things and statistics. Accountability is about creatively getting the intelligence into the system about what is happening and reacting to it positively, welcoming it and generating the complaints so that more intelligence comes into the system. That is the kind of accountability we want.

As Chairman of the Public Administration Committee, I feel I can add a new dimension to the debate because of what we are thinking about in our inquiry on the future of the civil service. We need to ask ourselves, “What does accountability feel like?” We think we know what accountability feels like, but my goodness, it goes up and down a bit. During the previous Parliament we felt very accountable in some periods, every single one of us. What do we want accountability to feel like in the health service? With the greatest respect to my hon. Friend the Member for Wycombe (Steve Baker), the lawyers must be the last resort. We do not want accountability to be about finger-pointing, blame and holding people to account. Indeed, that is part of the disease that afflicts the health service. We want accountability to be about nursing staff on the ward feeling accountable to each other for sharing information, accountable to the patients and welcoming the information they receive from them, and accountable to their managers and holding them accountable for what they do not feel is being done, in an atmosphere of trust and co-operation.

What is chilling about the Mid Staffordshire story is the question of what accountability felt like in that hospital at that time? To whom did people feel they were accountable. What did they feel they were accountable for? There must have been almost an atmosphere of “Apocalypse Now” in the hospital, in which nobody knew where to turn.

In the evidence we are receiving about the civil service, we have had powerful testimony from an adviser to our Committee, Professor Andrew Kakabadse of Cranfield university, who rather chillingly points out an obvious truth. Very few people who work in a failing organisation do not know that it is failing. Most people in a failing organisation know that it is failing. What is wrong? The answer is that they do not know how to talk about it. They do not know what to say, who to tell—or, if they try to tell people, it will be bad for them—or what to do. So people often just leave failing organisations, saying, “I can’t do anything about it.” I bet most of those on the board of the hospital trust knew it was going wrong and did not know what to do. There is this idea that this was just an isolated case, but it represents a systemic failure. There is absolutely no escaping that.

I remember the Paddington rail crash. One’s instant reaction was, “Well, the driver went through a red light; it must have been his fault,” but everybody knew that there must have been something much more fundamentally wrong. Something was wrong with rail safety. In aviation, when there is a plane crash, it is very rarely the pilot’s fault. Even if it is down to pilot error, that will be down to pilot training and that will be a system failure. We need to look at this issue in an holistic and sensible way.

The reaction of the NHS to the Francis report was immediately to reach for statistics and to start doing things. It immediately started a storm around our local hospital, the Colchester General, by latching on to one statistic and naming it as one of the hospitals being investigated, even though—I have written to Andrew Dilnot at the UK Statistics Authority and got a reply from him—a single statistic should never be used in such a fashion. In fact, the Colchester General is in the top quartile of its class of hospital, so that was entirely unnecessary. My wife has just had a knee replacement in that hospital. I was completely confident that she would get good nursing care and she indeed got very good nursing care.

There is now an uncomfortable atmosphere surrounding this issue. There is an atmosphere of denial, and this relates to Sir David Nicholson. Is he still in denial? Is the system still in denial? Can the system change dramatically enough unless people are seen to take responsibility for the culture? It is difficult to argue that he has not been individually responsible for the broad culture in the national health service that has led to this pass.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am sure the House wishes Anne Jenkin a speedy recovery.