Accountability and Transparency in the NHS

Phillip Lee Excerpts

Thursday 14th March 2013 Commons Chamber

[Dr Phillip Lee (Bracknell) (Con)]

As ever, it is an honour to follow the hon. Member for Vauxhall (Kate Hoey).

Let me begin by congratulating my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing a debate about this important subject. It is a subject that I think should be debated more often in the Chamber, and I find it surprising that fewer Members wish to speak about it than have wished to speak about some of the other issues that we have considered since Christmas. I think all Members should reflect on that.

I believe that the core of this problem is responsibility: responsibility in public life. The general public are fed up—not increasingly fed up, but completely fed up—with hearing about scandal after scandal involving the national health service, the BBC, the newspapers and so on, for which no one takes any responsibility. No one walks. No one looks at themselves in the mirror in the morning and says “I did not do as well as I should have; I am paid a decent wage; the honourable thing to do is resign”—not “be sacked”, but resign.

I do not want to make a speech about Sir David Nicholson. Sir David Nicholson should know that he ought to resign. I cannot comprehend how he can think that his position is sustainable from a moral standpoint, but if no morality is involved, what about competence? He may have been head of the strategic health authority for only a relatively short time, but he was aware of the mortality rates when he was in that job. What did he do about it? If he did nothing about it, why is he still in post? However, I do not want to make this a personal issue.

Having worked in the national health service for 13 or 14 years, I do not need to be told about the problems caused by the culture in that institution. I learnt how it was as a medical student, and I saw it at first hand as a junior doctor. I want to say something about that, and also about competence in general. We need competent individuals in charge of our hospitals and on hospital wards, but I am not sure that we have had them in recent years. I also want to say something about responsibility in the light of that.

The national health service is a huge institution—some might say too huge—and because of its size, the fact that it has grown over the past 60 or 70 years, and the fact that the people who work in it rarely leave, institutionalised behaviour is rife. It is rife in medicine and in management. In my view, former Secretaries of State on both sides of the House display such institutionalised behaviour themselves. They may wish to reflect on that at the end of the debate.

The first debate in the House in which I spoke, apart from the debate during which I made my maiden speech, was a Backbench Business Committee debate about compensation for haemophiliacs. I was struck then by the institutionalised response from the Department of Health. It seemed plain that the Department did not want to set a precedent by doing what was obviously the right thing, namely compensating about 4,000 people and their families for what the system had done to them.

I am therefore not surprised by the Francis report, which those who read it will discover to be a not particularly impressive document. Parts of it have the ring of a Nuremberg defence. It is remarkable that individuals cannot be held responsible for their actions within a system. That system is apparently so perfect that no one within it needs to be good. I think that we need a health service in which individuals, including Secretaries of State, take responsibility for their decisions at every stage.

[Mr Cash]

Was my hon. Friend surprised, as I was, that neither of the Secretaries of State who were in charge at the time were called to give evidence to the inquiry? Did he find that very strange?

[Dr Lee]

I did find it very strange. In fact, I find the behaviour of both former Secretaries of State strange all round. There is a constant blaming of—

[Mr Cash]

May I just correct one thing? The shadow Secretary of State was called to give evidence, but not the previous two Secretaries of State.

[Dr Lee]

I am talking about those who were Secretaries of State in the last Administration. In response to an intervention during his speech, the right hon. Member for Leigh (Andy Burnham) said, “I passed it on to Monitor.” The attitude that leads people to push away the process of decision making and take no responsibility for the outcomes needs to end.

[Andy Burnham]

Surely, as a clinician, the hon. Gentleman would resent the idea of politicians’ interfering in the independent clinical regulation of hospitals. I did not do nothing. Within days I had asked the Care Quality Commission to investigate the outliers that Brian Jarman had given me. I will not sit here and accept the hon. Gentleman’s suggestion that I complacently did nothing. That is not true, and he should not repeat it in the House.

[Dr Lee]

Despite that, nothing changed, did it? The CQC has a terrible reputation in my profession, and to have handed the matter over to it—when it was run by someone who was implicated at Mid Staffordshire—is not a defence.

Let me broaden the discussion to something that I may know something about: practising medicine in organisations run by the Department of Health. I can tell the House that the prevailing atmosphere is one in which attention is not drawn to problems. There is a fear for jobs down the line. Let me give an example. When I was a junior doctor, I misused a photocopying machine in a hospital. Within hours, I received a phone call from a middle-grade doctor telling me that if I did that again, it would affect my reference. The phone call, I was told, had been authorised by the then consultant general surgeon at St Mary’s, Ara Darzi. I reflected on that at the time. It made me feel rather intimidated. [Interruption.] The prevailing mood in hospitals was that seeing or doing something wrong could adversely affect a person’s future career.

[Charlotte Leslie]

Does my hon. Friend share my regret that Opposition Members are groaning in that way? What he is describing has been very evident for very many years. One need only speak to a doctor to learn that there is a culture of fear. Nearly every doctor knows someone who has tried to speak out against something that has happened. People know that if they do that, there will be counter-allegations against them. The groaning and expressions of surprise from Opposition Members are very sad, because it reveals just how little they were actually talking to clinicians on the ground who have been complaining about this for a decade. I received an e-mail from the spouse of a clinician who said that over the past 15 years the management styles encouraged by the previous Government had made that clinician ill.

[Dr Lee]

Of course my hon. Friend is right.

[Rosie Cooper]

Will the hon. Gentleman give way?

[Dr Lee]

I must get on, I am afraid. I do apologise.

The point I am trying to make is that a certain culture prevails, and into that culture, or environment, the last Administration introduced targets. I do not suggest for one second that the last Administration thought those targets would lead to the type of care that was provided at Mid Staffordshire, but I am not surprised that there were adverse consequences, and I think Opposition Members should reflect on that.

The final thing that I want to say about culture and competence concerns politicians. The right hon. Member for Leigh said that I would not want politicians to interfere in day-to-day care. Of course I would not, but I would like politicians to take responsibility for the service. Let me give an example. There are only about 250 acute trusts in the country, and not that many mortality figures have to be looked at in each trust. It could be done on a monthly basis. However, I am told that it was not done by Secretaries of State in the last Administration. Why? If I were the Secretary of State, the one thing I would want to look at would be clinical outcomes in hospitals. If that is beyond Secretaries of State, one is prompted to ask why they are in post. If those figures had been looked at earlier enough, we might not be having this debate.

Competence and the right culture are only possible with transparency. That is the most important aspect of this whole issue.

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Well, there’s a man who knows all the answers!

It was four years ago on Monday when I apologised to this House on behalf of the Government and the national health service for what happened at Stafford. We had just received the report from the Healthcare Commission, and I think it is fair to say that no one with any experience of the NHS could quite believe what had gone on. The people in charge at a time when there were unprecedented resources and investment being put into the NHS had cut staffing on A and E to such an extent that a receptionist with no medical training was triage nursing in A and E.

We need a longer debate. There is nothing ostensibly wrong with the motion, and I agree with my right hon. Friend the Member for Leigh (Andy Burnham) that we should support it, but it is clear from the way it was moved and the last contribution that this is all about the blame game. If I can just quote Francis—[Interruption.] Yes, the hon. Member for Bracknell (Dr Lee) does not agree with Francis or with Ara Darzi and knows everything, and says that Francis was a Nuremberg—

[Dr Lee]

rose—

[Alan Johnson]

No, I am not giving way—at least not to the hon. Gentleman. I have heard enough.

This is what Francis said in paragraph 108 of his report:

“To place too much emphasis on individual blame is to risk perpetuating the illusion that removal of particular individuals is all that is necessary. That is certainly not the case here. To focus, therefore, on blame will perpetuate the cycle of defensiveness, concealment, lessons not being identified and further harm.”

So the man who knows most about what happened at Stafford hospital—and who was entrusted by this Government and their predecessors to conduct not one, but two, inquiries, and who in four volumes running to millions of words sets out what happened, why it happened and how it was allowed to happen—counsels against the very action that this motion appears to propose.

Francis identified who was accountable, and the Secretary of State was absolutely right: it was the chief executive, the chair and the board of the Mid Staffordshire trust. A number of clinicians are also held accountable for the appalling lapse in standards of care at Stafford. This accountability regime is set out in legislation approved by this House.

The Francis findings are consistent with those that emerged from the inquiry into the care of children receiving complex cardiac surgery at Bristol Royal infirmary between 1984 and 1995. In that case, five individuals at the hospital, including the chief executive, were the subject of adverse comments. In respect of both Bristol and Stafford, an argument was made to an inquiry that there was an extenuating failure of national policy. At Stafford, it was national targets; at Bristol, it was inadequate resources.

It is worth recalling the Bristol inquiry’s response. Sir Ian Kennedy said:

“The inadequacy in resources for PCS”—

paediatric cardiac surgery—

“at Bristol was typical of the NHS as a whole. From this, it follows that whatever went wrong at Bristol was not caused by lack of resources. Other centres laboured under the same or similar difficulties.”

We must remember that these were the days when one in every 25 patients on the cardiac waiting list died before they could be operated on, and when somebody with a serious heart condition could wait a year to see the cardiologist, three months to see the consultant and then 18 months to two years for the operation. That is why targets had to be introduced—to get a grip on this awful situation.