Hospital Mortality Rates

John Bercow Excerpts

Tuesday 16th July 2013 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

I would like to make a statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.

Let me start by saying that in the health service’s 65th year, this Government are deeply proud of our NHS. We salute the doctors, nurses and other professionals, who have never worked harder to look after each and every one of us at our most vulnerable. We recognise that the problems identified today are not typical of the whole NHS or of the care given by many wonderful NHS staff; but those staff are the ones who are most betrayed when we ignore or pass over poor care. The last Government left the NHS with a system that covered up weak hospital leadership—[Interruption.]

[Mr Speaker]

Order. As is the normal practice, right hon. and hon. Members can expect extensive questions—as can the Secretary of State—but the statement must be heard.

[Mr Hunt]

Thank you, Mr Speaker. The last Government also failed to prioritise compassionate care. The system’s reputation—[Interruption.] This is uncomfortable for hon. Members. The system’s reputation mattered more than individual patients; targets mattered more than people. We owe it to the 3 million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head-on.

Following the Francis report into the tragedy at Mid Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series —Interruption.] I know they tried to shout down whistleblowers such as Julie Bailey, but we are not going to let that happen here. The Prime Minister asked Professor Keogh to conduct a series of “deep-dive” reviews of other hospitals with worrying mortality rates. No statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce.

Worryingly, in half those trusts, the Care Quality Commission—the regulator specifically responsible for patient safety and care—failed to spot any real cause for concern, rating them as “compliant” with basic standards. Each of those trusts has seen substantial changes to its management since 2010, including a new chief executive or chair at nine of the 14. However, although some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I am announcing today necessary.

This time, the process was thorough, expert-led and consisted of planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away, rather than waiting until the report was finished. We will be publishing all the reports today, alongside unedited video footage of the review panel’s conclusions—all of which I am placing in the Library. Today I will also set out the actions the Government are taking to deal with the issues raised. I would also like to record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.

Sir Bruce judged that none of the 14 hospitals is providing a consistently high quality of care to patients, with some very concerning examples of poor practice. He identified patterns across many of them, including professional and geographic isolation, failure to act on data or information that showed cause for concern, the absence of a culture of openness, a lack of willingness to learn from mistakes, a lack of ambition, and ineffectual governance and assurance processes. In some cases, trust boards were shockingly unaware of problems discovered by the review teams in their own hospitals. Today I can therefore announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care. In addition, the NHS Trust Development Authority and Monitor have today placed all 14 trusts on notice to fulfil all the recommendations made by the review. All will be inspected again within the next 12 months by the new chief inspector of hospitals, Professor Sir Mike Richards, who starts work today.

The hospitals in special measures are as follows: Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of “accepting sub-optimal care”; North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were closed immediately; Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break; and North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where both male and female patients were present. [Interruption.]

The list continues: United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 “never events” in just three years and the panel had serious concerns about the way “Do not attempt resuscitation” forms were being completed; Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, and of buzzers going unanswered and poor attention being paid to oral hygiene; East Lancashire Hospitals NHS Trust—[Interruption.]

[Mr Speaker]

Order. We cannot have a running commentary on the statement as it is delivered. I remind the House that last Wednesday—when there were scenes of grave disorder manifested by Members on both sides of the House—the public reaction to that exceptionally bad behaviour was understandably negative. I appeal to right hon. and hon. Members on both sides of the Chamber to show courtesy and restraint. They can rely upon me to protect their interests—if they were here on time for the statement—to question the Secretary of State, but the statement must be heard.

[Mr Hunt]

The panel also highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends at East Lancashire Hospitals NHS Trust. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.

The remaining hospitals in special measures are as follows: Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were seven “never events” in three years and concerns over infection control and overnight staffing levels; George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover, especially out of hours, a growing incidence of bed sores and too much unnecessary shifting of patients between wards; Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long accident and emergency waiting times; and Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.

For those 11 trusts, special measures mean that each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public. The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required. Each hospital will also be partnered with a high-performing NHS organisation to provide mentorship and guidance in improving the quality and safety of care.

Three of the 14 hospitals are not going into special measures. They are the Colchester Hospital University NHS Foundation Trust, the Dudley Group NHS Foundation Trust and the Blackpool Teaching Hospitals NHS Foundation Trust. Although there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.

This is a proportionate response in line with the findings of the review. Inevitably, there will be widespread public concern not just about these hospitals but about any NHS hospital, and some have chosen to criticise me for pointing out where there are failures in care, but the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out. The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved ones. Today’s review and the rigorous actions that we are taking demonstrate the progress this Government are making in response to the Francis report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate them in Government time.

The NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this, and we should remember that there continues to be much good care even in the hospitals reviewed today. Just as we cannot tolerate mediocre or weak leadership, we must not tolerate any attempts to cover up such failings. It is never acceptable for Government Ministers to put pressure on the NHS to suppress bad news, because in doing so they make it less likely that poor care will be tackled.

We have today begun a journey to change this culture. These 14 failing hospital trusts are not the end of the story. Where there are other examples of unacceptable care, we will find them and we will root them out. Under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems. There will be accountability, too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.

Hand in hand with greater accountability, there will be greater support. Drawing inspiration from education, where super-heads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary leaders such as David Dalton in Salford Royal and Dame Julie Moore of University hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.

At all times, this Government will stand up for hard-working NHS staff and patients who know that poor care and weak leadership have no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less. I commend this statement to the House.

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[Mr Hunt]

Mr Speaker, it is hard for a serving Health Secretary to admit that things can go wrong in the NHS, but we know today that it is even harder for a former Health Secretary. We have heard nothing but shameful denial. The right hon. Gentleman—[Interruption.]

[Mr Speaker]

Order. Mr Irranca-Davies, you look as though you are about to explode. I am worried about you. I think you probably need to have a lie down or to take some sort of medicament—it might be of benefit to you. You must calm yourself.

[Mr Hunt]

The right hon. Gentleman talked about being partisan and party political. It is not party political to highlight poor care; it is doing the right thing for patients.

Let us look at what independent people have said about Labour’s time in office. Roger Davidson, the former head of media at the CQC, said that

“there were conversations between the CQC and Ministers to the effect that the CQC would not cause any trouble…The message that ‘we don’t want bad news’ infected the whole organisation”.

Professor Brian Jarman—[Interruption.] I think Opposition Members might want to listen to this, because it is what independent people are saying. Professor Jarman, who invented hospital standardised mortality indices, said that

“the problem was ministerial pressure, even from Number 10.”

This is most damaging: the right hon. Gentleman talked about what Barbara Young, Labour peer and head of the CQC, said under pressure from the Labour Whips, but what did she say under oath to the Francis inquiry? She said that

“the government hated the idea…the regulator would criticise it… We were under more pressure, I think, when Andy Burnham became minister, from the politics.”

That is what a Labour peer said. These people are not Government supporters—at least, not of this Government —but were trying to do their job in exposing poor care and the right hon. Gentleman stopped them.

The right hon. Gentleman talks of spin, but I will tell him who had to fight hardest against spin: the whistleblowers he tried to shut up. What do they say? James Titcombe, who tragically lost his son at Morecambe bay, tweeted that

“you made big mistakes Andy, it’s time you admitted it.”

Julie Bailey, who lost her mother at Mid Staffs, said that Labour crushed the culture of care from the NHS. [Interruption.] Deb Hazeldine, from Mid Staffs, who lost a relative, said that the shadow Secretary of State was trying to “defend the indefensible”—[Interruption.]

[Mr Speaker]

Order. It is very difficult to imagine how anyone can hear these exchanges. The content of questions and answers is to be determined by Members, but I gently remind the House of the need for good order and that this is not a debate. There will be debates, but this is not a debate but a statement on which there is questioning, to which there is then a ministerial answer. This is not an opportunity for general speechifying but for responses to specific questions made with economy so that I can accommodate all interested colleagues.

[Mr Hunt]

Thank you, Mr Speaker. I would have hoped that the Opposition would want to listen more respectfully to what whistleblowers said about their attempts to expose poor care.

Let me respond to what the right hon. Gentleman says. He says that Labour tackled the problems, but the evidence shows the opposite. We talked about Tameside earlier, but what about Basildon? There were high death rates for nine years under Labour—in every year since 2001. Half the staff said they would not want their own friends and family treated there. Ministers received 237 letters between 2005 and 2010, yet what did the CQC do? It rated the hospital as “good” and within four weeks Ministers were shamed into launching an investigation into high mortality rates—[Interruption.]

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[Mr Speaker]

Order. I have tried to explain the position calmly—[Interruption.] Order. I shall do so once more. I think the Secretary of State will appreciate that he has been asked questions about present arrangements to which we need pithy replies, not a lengthy statement about events of the past that happened before he had responsibility. We cannot have that. If that is what he is planning to read out, we will simply move on. A brief conclusion to his answer is now required and sought by the House.

[Mr Hunt]

So, Mr Speaker, let me briefly take the final two points raised by the right hon. Gentleman. He says the trusts have got worse since 2010, but what does he do when I criticise the lack of progress—[Interruption.]

[Mr Speaker]

Order. My impression is that the Secretary of State is now seeking to treat of matters since May 2010 and he must be given the opportunity to do so, with colleagues and people outside being able to hear the answers.

[Mr Hunt]

Thank you, Mr Speaker.

What does the right hon. Gentleman do when I criticise the lack of rapid progress in tackling failure in our hospitals? He criticises me for making an unbelievable statement and states that there are no coasting hospitals, but today proves that he is wrong. What is unbelievable is his total refusal to admit that it is not just a question of coasting hospitals, but a Labour party that has coasted for too long on its reputation on the NHS.

Finally, the right hon. Gentleman says that we are trying—[Interruption.] This is difficult for Labour Members to hear, so let us get to the point. He says that we are trying to run down the NHS. Let me say this: if we did not believe in the NHS, we would not be tackling these problems. The best way to support the NHS is not to ignore poor care, not to muzzle the CQC, not to ignore requests for public inquiries and not to ignore warnings constantly. If founding the NHS is considered Labour’s proudest achievement, today is its darkest moment as a Labour Government are exposed as caring more about their own reputation than about our most vulnerable citizens in the NHS—[Interruption.]

[Mr Speaker]

Order. Has the Secretary of State finished his answer? He has. We are grateful and I thank him for saying that he has finished.

[Several hon. Members]

rose—

[Mr Speaker]

Order. I remind the House of the long-established and generally adhered-to convention that Members who were not present at the start of a statement do not rise to question the relevant Minister. That has long been regarded as a discourtesy, and it should not happen. I have a list of Members who arrived late, but I hope that they will not render it necessary for me to draw attention to the fact. I ask those who arrived late, in all courtesy, not to rise to their feet.

We will now make progress as expeditiously as we can, led by the Chair of the Health Committee.

[Mr Stephen Dorrell (Charnwood) (Con)]

Those who want to make the case for change in an organisation—and, after the Francis review, who can doubt the need for change in parts of the national health service—must first demonstrate the need for change. Does this review not build on the distinguished record of both Bruce Keogh and Sir Brian Jarman in demonstrating the need for change in parts of our national health service?

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

Thankfully, the quality of Sir Bruce Keogh’s report is vastly superior to that of the statement that we heard from the Secretary of State. Is it not the case that Sir Bruce Keogh—[Interruption.]

[Mr Speaker]

Order. I am very concerned about the fact that someone shouted something, and I think I heard a word that was unparliamentary. I did not see an individual who was responsible, and I do not know who was responsible, but I simply say to the House—[Interruption.] Order. It is no good people burbling on about whistleblowers from a sedentary position. Let us lower the temperature, and have orderly exchanges. [Interruption.] Order. I remind the House that I called the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) to ask a question. Let us do him the courtesy of hearing the conclusion of that question.

[Alan Johnson]

Is it not the case that Sir Bruce may have given us a blueprint for better regulation, provided that the Secretary of State faces up to his responsibility and ends the tawdry and squalid attempts by his party to denigrate his predecessors?

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[Margot James (Stourbridge) (Con)]

I warmly welcome my right hon. Friend’s break with the culture of cover-up that has been so prevalent in the past. I reject absolutely the shadow Health Secretary’s claim that the Dudley Group NHS Foundation Trust’s performance has deteriorated since 2010—[Interruption.]

[Mr Speaker]

Order. The hon. Lady is asking a question, but I have distinctly heard Members—in some cases identifiable Members—trying to shout her down. That should not happen on either side of the House. If she wishes to continue with her question, she may do so.

[Margot James]

Thank you, Mr Speaker.

I reject the shadow Health Secretary’s claim. The new leadership that was appointed to the trust in 2009 found deep-seated problems there. Does my right hon. Friend the Secretary of State welcome, as I do, the positive notes in Sir Bruce Keogh’s report about that new leadership’s abilities, and Sir Bruce’s finding that the overall work force at our trust are

“committed, loyal, passionate, caring and motivated”?

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Speaker]

Order. I am keen to accommodate as many remaining colleagues as I can, but I point out to the House that I must have some regard to the Second Reading debate on the Defence Reform Bill, so economy in questions and answers is now of the essence.

[John Stevenson (Carlisle) (Con)]

I welcome the Keogh report. Patients should come first and patient care should be at the centre of our health service. Over the past 10 years, sadly, there has been a clear lack of leadership and management at North Cumbria University Hospitals NHS Trust, so I am not surprised by the report. However, there is a possible solution to improve health care in north Cumbria: the acquisition of the hospitals by Northumbria Healthcare NHS Foundation Trust. Will the Secretary of State work with me, the regulators and Northumbria to ensure that the acquisition proceeds as quickly as possible so that the people of Cumbria and Carlisle get the best possible health care?