Francis Report

Sarah Champion Excerpts

Wednesday 5th March 2014 Commons Chamber

[Sarah Champion (Rotherham) (Lab)]

I welcome this debate because it has given us an opportunity to reflect, to learn and, hopefully, to not make some of the same mistakes again. I pay tribute to hon. Members who were directly involved with the events surrounding Mid Staffs. Their persistence in protecting their constituents and changing the culture has been remarkable and something we should all learn from. I particularly pay tribute to the hon. Member for Stafford (Jeremy Lefroy) for telling us how the staff at Stafford hospital have learned and are working as hard as they can to make changes, so that they can deliver an excellent service to all their patients.

The Francis report, published a year ago, made stark reading. It exposed the dreadful practices that no one should ever have to endure, with shocking stories of patients left in their own excrement, unfed, and pleading for water. My heart genuinely goes out to patients and their families who suffered such poor treatment at the hands of an NHS that was seemingly driven by apathy, not by quality of care.

One year on, have we learned the lessons that were so hard won? Robert Francis made many recommendations about how the NHS should put patients at the centre of care. He spoke of a structure of fundamental standards and measures of compliance. He discussed openness, transparency and candour throughout the system, all underpinned by statute. He also raised the need to improve support for compassionate, caring and committed nursing. A recent report by the Nuffield Trust reviewed the progress made, and there is some good news. Nursing is receiving a significant degree of attention, especially in ensuring fundamental standards of care, and the handling of patient complaints locally has been given renewed attention by the chairs of local clinical commissioning groups.

I think that complaints and compliments are key to improving practice, and like many Members, I use the Sheffield-based social enterprise website, Patient Opinion, which to date has shared 65,000 patient experiences of care and received millions of hits from the NHS, MPs, commissioners and the general public. There is clearly a desire for patients to share their experiences, and an NHS that wants to listen and learn. Is it not worrying, however, that an independent organisation is fulfilling that role? Although I am a huge advocate of Patient Opinion and fully support its work, the voice of patients and accountability should also come from within the NHS, not just outside it. In practice, under this Government patients still have little say in how their health care is commissioned or provided. As my right hon. Friend the Member for Leigh (Andy Burnham) stated, more than £10 million of the £43.5 million allocated to Healthwatch branches is still unaccounted for, so how can Healthwatch fulfil its role?

The Nuffield Trust also identified bad practice. I am saddened to hear that some national bodies have persisted in the behaviours towards hospitals that contributed to the problems identified by the Francis report. That suggests that there is still a fundamental lack of co-ordination between different NHS bodies, and elements of the system-based culture that led to the failings in the Mid Staffordshire trust, but while this is saddening, perhaps it should not be surprising.

For the changes Francis recommended to be implemented, they need to be fully adopted by the Government. Instead, the Government have spent £3 billion on a top-down reorganisation that nobody wanted and nobody voted for. Almost 1 million patients have waited more than four hours in A and E in the last 12 months and, as has already been pointed out, hundreds of mental health beds have been lost in the last two years. Last year, a third of people referred for counselling gave up because the waits were too long. Patients are still suffering at the hands of the Government.

If we do not urgently change the culture of the NHS to become more patient-centric, patients will continue to suffer. There needs to be a fundamental culture shift in the NHS that has not yet been achieved, and will not be achieved while the Prime Minister continues to put profits ahead of patients. The recent proposals to sell off our medical records are a perfect example of how “supposedly” patient-centred the Government are. Data collection and monitoring are essential, so it is a shame that the Government are stopping the collection of some datasets, such as health inequalities.

Staffing cuts are preventing patients from being at the centre of care. How can we provide patient-centred care when the Government are side-stepping the need for adequate levels of staffing, in terms of both volume and skills mix? How can we expect nurses to put into place systems, such as having a named nurse, when their numbers have been cut by around 7,000 since 2010? The Royal College of Nursing has said that it wants to deliver patient-centred care, but without the right skills mix in place, it is difficult for it to do so.

Continued “efficiency savings”, driven by a Prime Minister who promised not to cut the NHS, make it virtually impossible for patients to receive a service suited to their needs. A continual focus on savings suggests to me that the Government have not learned from the Francis report. Patients are not always seen as individuals with individual needs and wishes. Our changing society means changing patients, and changing patients have changing needs. Today, nearly two thirds of people admitted to hospital are over 65, and an increasing number are frail or have dementia. Too often, hospital buildings and staff are not equipped to deal with people who have multiple complex needs.

One of my concerns is that patient experience is still variable. We need to understand why experience differs and how we can make it consistently excellent for all. Will the Government commit to identifying and tackling the causes of inequalities in patient experience? Do they have the conviction to look at the needs of the patient and how they can be best met, rather than looking at existing provision and how patients can be shoehorned into it?

The problem is not necessarily what has been addressed by the Government, but what has not. The blame culture fostered by the Government leads to fear and finger pointing, rather than improved patient care. The Government need to commit to re-introduce a culture of learning, support, and quality patient care in the NHS. A blame culture will not get us anywhere: listening to patients, and taking their needs seriously, will.