Francis Report

Robert Flello Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

That is the problem. The Government’s focus is on hospitals. All the while, alternatives to A and E are being degraded and taken away. It is an undeniable fact that it has become much harder to get a GP appointment under this Government. The Patients Association warns that it may soon be the norm to have to wait for up to a week. [Interruption.] The Secretary of State says, “Nonsense.” He should get out and speak to people. The people I speak to tell me they are getting up in the morning and ringing the surgery at 8 am or 9 am, only to be told there is nothing available for weeks. As my hon. Friend the Member for Stockton North (Alex Cunningham) said, they ring 111 and the advice given is to go to A and E.

The Government have created the situation that the Secretary of State will not address. He wants to put it all in his own terms, but this is the reality in the NHS right now and this is what has happened since the publication of the Francis report. He has put more pressure on hospitals, because he has made it harder for people to get a GP appointment, and hospitals today face greater difficulty in meeting their targets. Indeed, as I just said, in the 12 months since the Francis report, hospital A and Es have missed the target 32 times running. These issues go to the heart of what we are debating today.

[Robert Flello (Stoke-on-Trent South) (Lab)]

Constituents across the country will be really concerned that the Secretary of State was shaking his head when my right hon. Friend noted the fact that hospitals are under pressure and that that will have an adverse impact. Macmillan Cancer Support notes that four in 10 people are leaving hospital without enough support from health and social services. That shows there is a crisis across the entirety of the NHS, not just in A and E.

[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.

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[Jeremy Lefroy]

I thank the hon. Lady for her intervention, but that task is probably beyond my competence. I agree that we should use HSMRs and respond to their signals, but we should not say that they are the final judgment on specific numbers. Any HSMR that looks difficult and looks as though it needs to be investigated must be investigated—it is much better to do so than not to do so.

I will now discuss my own constituency, which, along with those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson), has probably been the most affected. The spotlight has been on Stafford hospital for several years now, and it has been an extremely difficult time for those who raised their concerns, such as Julie Bailey and Cure the NHS, which were dismissed in a very offhand way by the NHS system and for which they endured abuse; it has also been extraordinarily testing for the many people working at that hospital and the one in Cannock, who have tried to carry out exemplary care at a time when the spotlight has been on them. They have, by and large, brought excellent care to patients, despite what has been going on around them. Understandably and rightly, the Care Quality Commission carried out an unannounced visit on the very day last week when it was announced that the Mid Staffs trust would be dissolved, so hon. Members can understand the sort of pressures that staff have faced. The great improvement that has been made has been recognised by the CQC and, most importantly, by patients and their loved ones. There is no complacency; there are still instances that should not happen, and the hospital and the trust are determined to ensure that they learn from all those. For Stafford and Cannock, however, it has also been a time of coming together and putting aside differences, as tens of thousands of people have worked together to save our hospitals and their services.

I will not dwell at length now on the process, the administration and the dissolution of the trust announced last week, but I will seek a debate on it, because some of the points made by the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), are fair in respect of the way the process works—or does not work. I have been critical of it and will continue to be so. I will, however, dwell on the unity. I have marched twice, not only with people who have had wonderful care at Stafford, but with some who have told me that they, too, experienced very poor care at Stafford but wish, for the sake of everyone, to see both patient safety and care improved, and services protected. Last week, the trust’s dissolution was announced, and although most services will continue, I continue to oppose decisions that mean the potential loss of consultant-led maternity services, consultant-led paediatrics and in-patient paediatrics. I will continue to fight for those services, because I believe they are essential in a hospital and a place that is at least 30 km away from the nearest other possibilities for patients. I urge NHS England, in particular, to take the consultant-led maternity review very seriously indeed.

[Robert Flello]

I pay tribute to the hon. Gentleman and the hon. Member for Stone (Mr Cash) for the work they have done. On those maternity and other services at Mid Staffs, may I say that the hon. Gentleman has support in Stoke-on-Trent South?

[Jeremy Lefroy]

I am most grateful to the hon. Gentleman, to all the Stoke-on-Trent MPs and to the hon. Member for Newcastle-under-Lyme (Paul Farrelly) for the way in which they have approached this matter together with us. We will be working with them under the new trust arrangement, with the University Hospital of North Staffordshire NHS Trust, and it is very important that we work together.

I refer to unity because the only way in which we will develop a health service fit for the 21st century is by showing that same unity of purpose nationally. I pay tribute to my hon. Friend the Member for Bracknell (Dr Lee), who is no longer in his place, for his remark about working together, and I absolutely agree with it. When the Prime Minister and the Leader of the Opposition, and later the Secretary of State and his shadow, have made their responses to the Francis report in the past year, they have been of the highest quality; they have shown a true appreciation of the gravity of the subject and the importance of a mature response.

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[Joan Walley]

I think that there has been an extraordinary degree of cross-party support from all Staffordshire MPs for efforts to get the matter on the agenda. When we look at the initial inquiry called by the Labour Government, its extension and then its translation into a full public inquiry by the current Government, and when we consider how quickly we as parliamentarians need to ensure that we hold the Government to account, we must recognise, as the hon. Gentleman says, that it has taken an extraordinary amount of time to get this debate.

At the heart of this debate is the need not only to discuss something that affects the whole country and Wales, as we heard from my right hon. Friend the Member for Cynon Valley (Ann Clwyd), but to see what lessons the three inquiries have to teach us. One of the Francis report’s main recommendations is that it is also for Members of Parliament to question ourselves on how we hold our own trust boards to account. In a way, we need the ammunition to be able to do that. I know that the previous Member for Stafford genuinely tried to get answers on what was happening at the time from the then trust board, but those answers were not forthcoming.

[Robert Flello]

If I understand the situation correctly, the previous Member for Stafford was lied to when he tried to inquire about those issues. How on earth are Members of Parliament, with the scant resources available to us, supposed to get to the bottom of things when we are being lied to?

[Joan Walley]

That encapsulates the problem of Members of Parliament trying to get to the bottom of what is happening but being denied the information. I think that the main thrust of the report is a call for transparency and openness, for freedom of information, so that we can get informed decisions being made at local trust board level on the future direction of policy. The issue is how that is constrained by the available finances. One regret is that the finances do not come into the Francis report to the extent they might. We know that at the local level those in charge of health services are trying to ensure that they deliver a service within the financial constraints.

[Joan Walley]

It may surprise the hon. Gentleman to know that I agree with him, and that the target culture has a lot to answer for. We have moved on from that now, and we are looking at how to achieve the best possible health care within the available resources. As my right hon. Friend the Member for Leigh (Andy Burnham) said, it is important to have integration, cross-cutting services and collaboration. We must move on from the target culture to look at the best possible way to achieve high standards of service throughout the country and stand-alone services in localities.

I want to put on the record my concern that lives were destroyed and that many people and their families were severely affected by what happened as a result of the systemic failures in the Mid Staffordshire NHS Foundation Trust, and specifically at Stafford hospital. There are many lessons to be learned, and we owe it to them to ensure that we move on and get the right hospital services.

For the record, may I say that at the time I supported the call for a public inquiry? I say that from these Benches.

Whatever the mechanism, the heart of the matter is that we must learn the lessons and move forward. It is right to debate the broader issues, values and culture of the NHS. We must recognise that an integral part of that is the procedures to deal with a failing hospital. As we assess progress on the implementation of the Francis report, it is vital to hold the Government to account for their handling of the parallel process—the trust special administrator’s report. It is essential for those of us in Staffordshire to have clarity from the Secretary of State—I am sorry he is not in his place—on future arrangements for health care in Stafford. That is what most concerns me and I shall concentrate my comments on that.

Reference has been made to how fit for purpose the trust special administration process is. Is it just about finances, or is it about the broader health care that should be provided? Changes are being introduced in the Care Bill, which will come to the House on Monday. The Government must address how stuck we are with the TSA and the TSA reports, and whether they are broad enough to deal with breakdown and failure in individual hospitals. Obtaining a resolution on how current hospital services in Staffordshire are being taken forward is urgent. That is part and parcel of how we take forward the lessons that the Francis report identified.

For me, the most important paragraph in the Francis report’s terms of reference is identifying

“the lessons to be drawn from that examination as to how in the future the NHS and the bodies which regulate it can ensure that failing and potentially failing hospitals or their services are identified as soon as is practicable”.

On the trust special administrators, we should aim to identify what needs to be done in advance of a hospital failing. In Staffordshire, we are stuck with a procedure. A report was carried out and sent to Monitor, and there was public consultation, which took place only in the Mid Staffordshire area. It is a great concern that when a hospital—in our case, the University Hospital of North Staffordshire—makes a proposal to rescue some of Mid Staffordshire’s services, there has been no corresponding consultation in that area about the impact of the changed configuration of health services in north Staffordshire. That is a real failing and the Government should take it on board.

[Robert Flello]

My hon. Friend is being generous with her time. There is an issue, which the hon. Member for Cannock Chase (Mr Burley) talked about, of work going across to that hospital. The bizarre situation is that different treatments are at cost, more than cost or less than cost. It may be the case that work that ends up at the University Hospital of North Staffordshire is below-cost work, and that work that ends up at Cannock is above-cost work, so they will be a disparity in funding.

[Joan Walley]

My hon. Friend makes a good point, and I see nods on both sides of the House. We have a tariff system and there are extra needs in more vulnerable and deprived areas. The nonsense in accident and emergency services is that hospitals are criticised and penalised for treating too many patients when we have seen how GP appointment systems are breaking down. That goes back to the recommendation in the Francis report that NHS provision should be looked at in the round and in its entirety. The trust special administrator just looks at the detailed finances and the assumptions that underpin the finances. That is wrong, and that is what we should concentrate on.