Francis Report

Phillip Lee Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

Time is against us, I am afraid.

The Secretary of State is wrong if he thinks that top-down regulation is the only answer. It cannot prevent things from going wrong in the first place. The Secretary of State should accept all the recommendations of the Francis report, including the recommendations that are designed to change the culture at a local level.

Let me now turn to the future of Stafford hospital, and address the point made by the hon. Member for Stone (Mr Cash). If there was one thing that the people of Stafford deserved after what had been a long and painful process, it was the legitimate expectation that, at the end of that process, they would see a fully functioning local hospital that was both safe and sustainable. That is why I believe that the conclusion of the trust special administrator process is both wrong and unfair on them. It will result in a significant downgrade of the hospital, and there is still no clarity in regard to important services such as maternity.

The issue of the future of Stafford hospital goes to the heart of the handling of the inquiry and the decisions made about it. When I arrived at the Department of Health in June 2009, the official advice that I received was that I should not hold any further inquiry into what had gone wrong, because it would distract the hospital from the essential task of making immediate improvements. I could not accept that advice, because I believed that we needed to get to the full truth of what had gone wrong. That is why I appointed Robert Francis to conduct an independent inquiry. However, I stopped short of a full public inquiry because I had been warned that such an inquiry could destabilise the hospital and prevent it from making improvements. The Secretary of State nods.

That is the advice that I was given, but I told Robert Francis that he could come back to me and ask for powers to compel witnesses to appear before him if he felt that that was necessary. He came back to me to say that he felt that he had had all the co-operation that he needed. Indeed, he had had more, because of the nature of the inquiry that I had set up.

As the Secretary of State will recall, after the first Francis report I commissioned a second-stage inquiry into regulatory systems. I did not disagree with the coalition’s decision to upgrade it to a full public inquiry, as that was always a finely balanced judgment, but I did warn at the time that the hospital would need further support, given what a full public inquiry would entail. I do not believe that it has been given that support. Worse, the administration process that it has undergone has been brutal. I do not believe that there is a district general hospital in the land that could survive a three-year public inquiry followed by financial administration. The Labour party’s view—informed by the Lewisham and Stafford examples—is that the Government are misusing the administration powers created by the last Government to drive through reconfiguration on cost rather than clinical grounds, and we will therefore move to delete those powers from the Care Bill next week.

[Dr Phillip Lee (Bracknell) (Con)]

The right hon. Gentleman has alluded to the sustainability of district hospitals. In the light of the Francis report and the dreadful care failings at Mid Staffs, I would suggest—and I am sure that others would agree with me—that part of the problem was that we were trying to offer care over two sites to a relatively small population. The right hon. Gentleman agrees with me that reconfiguration of acute care in particular is on the horizon. Does he also agree that, in view of the political difficulties of acute reconfiguration and the ultimate closures of departments, a cross-party approach is long overdue?

[Andy Burnham]

The hon. Gentleman makes a very important call, and I think he is right: hospitals are going to have to change, and the sooner we all wake up to that fact, the better. I would also say to him, though, that hospitals cannot be changed top-down, as I believe his Government are trying to do with clause 119 of the Care Bill: a power to drive through financially driven reconfiguration and create a twin-track route outside of the normal, established process. The normal process creates local oversight and scrutiny at democratic level, and independent judgment on changes from the Independent Reconfiguration Panel. That is the established route and it should not be bypassed. I say that while agreeing with the hon. Gentleman that we do need a cross-party approach.

I believe we owe it to the people of Stafford to support their hospital and maintain as many services there as possible. If the Secretary of State were to visit Stafford and sit down with people on the Support Stafford Hospital group, as I have done, he would hear a real sense of injustice from them that their hospital has been dragged down by a barrage of negative publicity. Will the Secretary of State confirm today whether Stafford hospital will continue to have a maternity service? Rumours and nods and winks are no good; people need to know. What will he do to ensure that the people of Stafford do not have to travel miles to get basic services? I can tell the House that I will continue to argue for the fullest range of safe services at Stafford, as that has been my consistent aim throughout this entire process.

Perhaps the most unseemly aspect of the last year has been an attempt by some to politicise the failing at Stafford. That has created a climate of fear in the NHS that may make it even less likely that doctors and nurses feel able to report mistakes or poor care and achieve the culture change that the Francis report advocated. I would like to remind those on the Government Benches that this stands in stark contrast to the way the previous Government handled the care failures they inherited from the Government before them at Bristol and Alder Hey, and also the Shipman murders. At Bristol, doctors raised concerns but were not listened to. Parents whose children had died or suffered brain damage were ignored. For a long time nothing was done. It was in 1997 that the General Medical Council finally started to investigate what had gone wrong at Bristol. I say to those on the Government Benches, for goodness’ sake please remember and take the long view on these issues. Let us all use these moments by making them a catalyst for change in the NHS.

NHS staff report to me that they now feel a climate of fear and an intensification of the blame culture, with the talk of uncaring nurses, lazy GPs and coasting hospitals. We have seen HSMR—hospital standardised mortality ratio—figures misused by Government spin doctors to generate misleading headlines that have damaged struggling hospitals. It even got to the point where a group of senior clinicians and managers felt compelled to write to The Guardian at the end of last year, calling on the Government to call off the attack dogs. They feel that there is an attempt to magnify the failings of the NHS and run it down, and that it is linked to a drive towards more privatisation.

What the NHS needs to address some of the major issues that the Francis report raised is the ability to collaborate and integrate. The great sadness is that the Health and Social Care Act has placed it on the opposite path, towards competition and fragmentation. We now have the unbelievable spectacle of the Competition Commission intervening for the first time to prevent sensible collaboration between hospitals. The logical consequence of “any qualified provider” is more and more providers dealing with one person’s care. This is a recipe for cost, complexity and fragmentation.

I am clear that the market is not the answer to 21st century care. Instead, we need services based around the individual, starting in the home, with all barriers to integration are removed. That is essential if we are to rethink the care of older people as the Francis report invites us to do, and this shows the big difference between those on this side of the House and those on the Government Benches. They talk about integration but have instead legislated for fragmentation. Only by repealing the Health and Social Care Act will we put that right, put the right values back at the heart of the NHS and build an NHS ready for the 21st century.