Accountability and Transparency in the NHS

Steve Barclay Excerpts

Thursday 14th March 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

What happened at Stafford hospital was a betrayal of everything the NHS should stand for. We will face up to what went wrong and I will say more about that today. I repeat the apology to the families of people who suffered appalling abuse and neglect.

We must do more. People affected will be watching this debate and rightly wondering what it will achieve. They want to know what is going to change and when. The time has come for cross-party agreement on a way forward, and that is my hope for this debate. There must be more accountability and transparency, and that is why we support the motion.

We also support the Secretary of State’s ban on gagging clauses. It builds on statements made by the previous Government, which in turn were a response to previous scandals. That provides a crucial context for today’s debate.

In 1997 Labour inherited the job of responding to the Bristol heart scandal and the Harold Shipman murders. A series of major policy developments followed on patient safety, inspection and regulation. We passed the Public Interest Disclosure Act 1998, protecting whistleblowers. We published data that had never before seen the light of day on survival rates from heart and stroke care, and 1999 saw the first ever independent regulation of hospitals and care standards.

In 2001 we established the National Patient Safety Agency, which has sadly since been abolished and, in 2006, on the back of the public inquiry by Dame Janet Smith, the General Medical Council and the Nursing and Midwifery Council were reformed to end the professional closed shop. The truth is, however, that well-meaning as those steps were, there were places where the underlying culture of the NHS did not change and that is an important lesson for us all. When we make statements in this place and pass policies, we assume that everything changes on the ground, but it does not.

The previous Government made similar statements to that made by the Secretary of State today, yet the use of agreements persisted. Why was that? The answer is that there is a culture in the NHS—a tendency to pull down the shutters and push people and complaints away when things go wrong—that is more ingrained than we might think.

[Stephen Barclay (North East Cambridgeshire) (Con)]

On the subject of pulling down the shutters, will the right hon. Gentleman confirm that the world-leading expert, Professor Sir Brian Jarman, wrote to him in March 2010 listing concerns about 25 hospitals with high mortality rates, and that both the right hon. Gentleman and the Care Quality Commission took no action?

[Andy Burnham]

No, I will not. I was copied into an e-mail by Professor Brian Jarman in mid-March 2010 and, having asked the CQC to investigate what he had said, I wrote back to him on 31 March 2010. That was literally my last duty as Secretary of State for Health after the general election was called. I was not able to respond further to inquiries. It is important to provide some balance to the hon. Gentleman’s comments.

Changing the culture in the NHS requires vigilance and persistence. As Robert Francis says, we have all been too remote from the front line.

The foundation trust reform was a serious attempt to end the top-down culture in the NHS, bringing more accountability and transparency. If we look back, however, we will see that, when the centre stood back, there were places where an unhealthy local culture became even more firmly established. In some trusts a national top-down style was replaced with a local top-down, bullying style, which can be even worse. I can remember the shock I felt on reading the first Francis report’s finding that, on receiving FT status, one of the first things that the Mid Staffs board did was to resolve to hold more meetings in private. That was an audacious breach of the spirit of the legislation passed by this House.

--- Later in debate ---

[Mr Hunt]

I accept that progress was made in the collection of data and that the previous Government set up a star rating system. The problem, however, was what it measured. It did not measure the quality of patient care but basically focused on access targets. It was possible for a hospital to get a three-star rating by transforming its 18-week access targets, even at the expense of patient care.

[Stephen Barclay]

It is correct that improvements were made in the collation of data. In fact, the Dr Foster data were published in national newspapers from 2001, but what is remarkable is that they were not acted on. That is the central charge for Ministers. We were the world leader in the collation of mortality data. We had the data, but Ministers did nothing with them.

[Mr Hunt]

My hon. Friend speaks wisely. Hospitals display 1,400 different pieces of data, but the question is why nothing is done when the data give dangerous messages.

--- Later in debate ---

[Stephen Barclay (North East Cambridgeshire) (Con)]

I join other Members in welcoming the Government’s announcement today of a ban on gagging clauses, but is it not surprising that we need such an announcement? The right hon. Member for Holborn and St Pancras (Frank Dobson) has just told the House that he issued guidance on this issue in 1999, and we also have the Public Interest Disclosure Act 1998 and the 2004 guidance. My right hon. Friend the Member for South Cambridgeshire (Mr Lansley) even put these conditions in the NHS constitution, and yet we find that we need an announcement on the matter today. My hon. Friend the Member for Stone (Mr Cash) has been repeatedly assured that there is no problem. I raised the issue in some detail with Sir David Nicholson in the Public Accounts Committee on a number of occasions, and I was constantly told that there was no need for change, so does Sir David agree with today’s announcement? Indeed, is a change being announced? Will the Secretary of State confirm that this announcement covers all payments, including those through judicial mediation, and will it apply retrospectively?

There seems to be a striking uniformity as between both Front-Bench teams when it comes to telling us that Sir David Nicholson is a wonderful manager, yet he did not know about the high mortality figures—even though they have been published in national newspapers since 2001; even though his own staff were logging in to the Dr Foster data; and even though the figures were high when he was the chief executive of the strategic health authority that was responsible for Mid Staffordshire. He did not know about gagging clauses when he was the accounting officer; he did not know about fixing mortality codes, yet they are now subject to police investigation. As he told the Health Select Committee, he did not know about judicial mediation—a flaw in the system, yet he is responsible for system and controls. He did not know about the Gary Walker case.

My hon. Friend the Member for Bristol North West (Charlotte Leslie) says that she has concerns about the US reports, but once again, Sir David seems not to know about them. He did not know about the Royal College of Surgeons 2007 report into Mid Staffs, which raised serious concerns, as my hon. Friend the Member for Stone is well aware, but in respect of which no action was taken. In other areas, too, we should remember that he was not just the accounting officer for the wonderfully successful NHS IT programme, but the senior responsible owner. We are told that he is a great manager, but it is difficult to see the evidence to sustain that claim.

[Mr Cash]

In a conference on 4 October 2012, I understand that Sir David Nicholson said that

“the senior leadership of the NHS and I was part of it in those circumstances”

but “lost the plot”. He continued:

“We lost the reason why we were there. We got so excited about…changes”,

but he went on to acknowledge that

“on ward 10 in Mid Staffordshire Hospital really bad things were happening”.

That is the sort of admission that he had to make in those circumstances. Does my hon. Friend agree that that amounts to admitting responsibility for the system’s failure?

[Stephen Barclay]

I do agree with my hon. Friend, and that does seem at odds with the Government’s welcome commitment to promoting individual accountability. In response to the Robert Francis report, the Prime Minister talked about three fundamental problems with the culture of the NHS. Of course that went beyond one individual.

I am concerned about the timing of the announcement of the appointment of Barbara Hakin, a close ally of Sir David Nicholson. It is important to note that she is innocent of any allegations being made against her, but I understand that she is under investigation at the moment. The timing of the appointment, then, seems strange. I invite my right hon. Friend the Secretary of State to intervene to clarify whether he was told of Barbara Hakin’s appointment prior to it being made. If he was not told, does not that say something about the power that Sir David wields within Richmond House?.

A further issue is whether Parliament knows the quantum or scale of the payments made to whistleblowers. I have repeatedly raised this matter over the last two years and was finally given a figure of £15 million paid over three years—silencing quite a lot of people. It now emerges, however, that that is not the whole story, as it does not cover payments such as the one for Gary Walker, which was paid through judicial mediation.

As seen in the NHS manual for accounts, each NHS body or trust is required to compile a register detailing all special payments made, including those through mediation. As I understand it, even the Department of Health does not know how many such payments have been made—and that applies to the Treasury, too. In a response to my parliamentary question this Tuesday, the Minister said:

“Approval has not hitherto been required by the Chancellor or the Secretary of State for Health for special severance payments made as a result of judicial mediation. However, as of 11 March”—

this Monday—

“approval will be required.”—[Official Report, 12 March 2013; Vol. 560, c. 182W.]

The position seems to be moving as of this week. Parliament does not know how much has been paid to whistleblowers, so will the Minister clarify when we will know?

In my Adjournment debate of a week last Monday, my hon. Friend the Member for Bracknell (Dr Lee) asked whether the chief executive of Mid Staffs was subject to a gagging clause. We received a welcome reassurance that we would be given an answer, but when we were on our way to the Chamber for this debate, my hon. Friend told me that he had received none. I hope that the Minister will clarify whether Mr Yeates was subject to a gagging clause.

[Mr Burley]

Is my hon. Friend aware that Mr Yeates left in 2009 with an £80,000 pay-off and a six-figure pension lump sum before moving to a job with a charity called IMPACT Alcohol and Addition Services, based in Shropshire, and that he refused to give oral evidence to the inquiry because of a unique form of post-traumatic stress disorder? Where is his accountability?

[Stephen Barclay]

My hon. Friend is right. Not only did Mr Yeates leave with, I understand, a significant payout, but he went to work for a charity that was in receipt of Department of Health funds. I think that as a matter of urgency we should clarify the terms on which Mr Yeates left the NHS, what Ministers knew, and what senior officials—in particular, David Flory—were aware of at the time of his departure.

I fear that we are in danger of sending a confused message to staff and families of patients in the NHS. On the one hand we say that the culture needs to change, but on the other we say that the people who are responsible for that culture—the people who are paid significant sums to lead it—should stay.

My hon. Friend the Member for Totnes (Dr Wollaston) is absolutely right: there is much in our NHS that we should celebrate and of which we should be proud. However, we do it a disservice if we are not prepared to identify where it is going wrong, and to be transparent about the areas with high mortality and about the existing culture which has a chilling effect on those who are brave enough to speak out. Is it not informative that the one person who spoke out at the Bristol inquiry, and who did so much good, is the one person who has never worked in the NHS again?

I think that the challenge for the House today, and in subsequent weeks, is to ensure that this time it learns the lessons that were clearly not learnt then.