Accountability and Transparency in the NHS

Thérèse Coffey Excerpts

Thursday 14th March 2013 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I wish to thank my hon. Friend the Member for Bristol North West (Charlotte Leslie) and the Backbench Business Committee for calling this debate. I particularly wish to remember all those in my constituency and elsewhere, and their loved ones, who suffered so grievously. I wish to pay tribute to those here today who campaigned to bring these things to light. I also thank the Prime Minister, the Secretary of State and all other hon. Members for their response to the report a month or so ago.

One of the main thrusts of the Francis report is to:

“Ensure openness, transparency and candour throughout the system about matters of concern”.

This is not the time to debate the Francis report fully—it was commissioned by the Government and it needs full and prompt consideration in Government time—but it is the time to say that the Francis report is of great importance. Mr Francis rightly dismisses the arguments of those who claimed at the time that the inquiry was unnecessary because Stafford hospital was a solitary exception—it was not. It may have been considerably worse than other places, but appalling standards of care have been revealed elsewhere.

The public inquiry has revealed complacency throughout the NHS and beyond; report after report detailed major concerns, which were either ignored or passed to others to deal with. What lay behind that? Perhaps it was a lack of willingness to shout and continue to shout for help when it was needed; or perhaps it was more often a fear of the consequences—the loss of one’s job or the removal of services from the local community.

Even just last week, when, as the shadow Secretary of State rightly said, a report to Monitor suggested removing most emergency, acute and maternity services from Stafford—something my constituents and I strongly oppose for reasons I set out in the House last week—there were those blaming Julie Bailey for the proposals. That comes on top of disgraceful threats—even death threats—that she has received over her work in revealing what Robert Francis, who should know if anyone does, calls the “disaster at Stafford Hospital”.

Let me make it clear that the proposals in the Monitor report are, in the main, a consequence of the financial and clinical pressures that all acute trusts, particularly the smaller ones, are facing. Stafford’s circumstances have done a little to hasten changes, but what happens at Stafford now will face all other such trusts in the coming years. That it is why it is so important that Monitor and the Secretary of State come to a good solution for Stafford, and indeed Cannock, and I will continue to work with them and with my hon. Friends on that. Nobody should take from the Monitor report the message that whistleblowing or more transparency will result in threats to their local services. Indeed, Monitor would be acting contrary to section 62 of the Health and Social Care Act 2012 if it acted in such a manner.

Let me raise another, perhaps more justified, fear of the unintended consequences of transparency. Only this week, I heard of a case where a patient could have a life-saving operation, but his chances of surviving it are only 50:50, yet without an operation he will die. Some surgeons are, even now, reluctant to take on the operation because if the patient dies, it will be counted against them in their personal mortality statistics. That is an unintended consequence of transparency, so transparency has to be balanced with understanding the context; otherwise, we will end up with a risk aversion that is so great that patients will suffer.

Transparency can also thrive only in a culture that is not led by blame. One of the doctors who gave evidence to Francis said:

“There was a blame-led culture, the culture being that problems had to be fixed or nursing jobs would be lost.”

How can we persuade the most suitable people to take up vital, often voluntary, roles on trust boards if their attempts to raise problems are met by blame or indifference? As my hon. Friend the Member for Southport (John Pugh) said, transparency must start right here in Parliament. He spoke movingly about moral purpose, and I agree with what he said.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I agree that we do not want to deter people from becoming board members, but surely my hon. Friend must agree that if things are still going wrong and the board is not holding the chief executive and the leadership to account, its members’ positions should be questioned.

[Jeremy Lefroy]

I would never disagree with that. I entirely agree with what my hon. Friend says, but there is a danger that there will be so much adverse scrutiny that people will be afraid to come forward. We must challenge that and say, “You have every right, as a board member, to raise whatever you want, whenever you want.”

As I was saying, we need a proper debate here in Parliament on health care in this country, one not constrained by party dogma or blind nostalgia. It is up to us to have that debate and, as a result, give clear direction, rather than simply to react to whatever is thrown at us. We need to debate, for instance, the nonsense of pretending that it is entirely the responsibility of local trusts to deliver. So much is out of their control, be it per-patient funding, which is still far too variable, clinical standards, which are set almost in a vacuum by the royal colleges, or the impact of the European working time directive on costs, rotas and training. We need to debate the impact of the large number of specialisations in the UK—we have 61 as against Norway’s 30—which is driving up costs and driving out vital general medical and surgical expertise. We need to debate emergency and acute tariffs, which have, for many years, meant that hospitals around the country are squeezed and face forced reconfigurations that may not be in the best interests of patients.

Robert Francis also says that one of the main principles is to:

“Make all those who provide care for patients—individuals and organisations—properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service.”

He also says:

“There must be a proper degree of accountability for senior managers and leaders.”

Accountability was sorely lacking at Mid Staffs. There were attempts to see that responsibility stopped with the board. As I have already said, that is based on the fiction that it is somehow entirely in control of its own destiny. It is not. That does not absolve the board or management, but the responsibility is shared by those who determine so much of the environment in which they operate, including us here. Professional organisations, for instance, have procedures that make it difficult to dismiss staff who are unsuitable. The Government signed up to the working time directive without preparing for the financial and manpower consequences. And for managers, and indeed politicians, targets became more important than care itself. Again, that is our responsibility.

I have already said how strongly I oppose the blame culture, and I am not going to start blaming, but accountability involves responsibility, and far too few people have taken sufficient responsibility in this case. We must reflect and they must reflect on the message that that sends.

Too many inquiries have been left to gather dust on Department shelves, and not just the Department of Health. I and my hon. Friends the Members for Cannock Chase (Mr Burley), for South Staffordshire (Gavin Williamson), Stone (Mr Cash) and Members further afield, all of whom are affected, will not allow this one to gather dust.

--- Later in debate ---

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to contribute to this important debate, and I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie), and other Members, on securing it. Transparency and accountability are the hallmark of good governance, but they can involve issues such as whether a patient is on the Liverpool care pathway, whether that is transparent and whether their families know, not solely about the running of a particular trust.

I welcome freedom of information requests, which are among the most useful tools available to a Member of Parliament trying to secure information on data held by hospitals, ambulance services and so on. It is extraordinary, however, that we must resort to those tools to try to get that information and help in holding the people running our services to account.

I accept that the NHS is a complex organisation—imagine a hospital that has issues with bed-blockers, social care, or people trying to find a place in a home, or where ambulances are exceeding their handover targets. Those are interlocking issues. I still think, however, that it is important to hold the chief executives and boards of these trusts to account.

I was late today because I was at a meeting with the chairman and chief executive of our ambulance trust. This is not the first time I have had to work with other MPs to highlight particular failures. In a Westminster Hall debate, I called for the chairman of James Paget hospital to step aside. I have not made that call today. I have asked the chairman of the board to consider carefully the potential issues arising from the CQC report that is due to come out at any moment. It is frustrating that in trying to hit the target people often miss the point. The point is to care for patients.

The Care Quality Commission and Monitor were mentioned earlier. I welcome the changes made by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) to introduce unannounced spot checks by CQC. A lot of issues were unveiled as a result of the changes and that is to be welcomed. I welcome the recommendation to merge the CQC and Monitor, as there is a risk of ambiguity over exactly which body is holding people to account. I welcome the move by the Secretary of State to have Ofsted-style inspections. I am sure he will learn lessons and ensure that they are focused on clear issues, and not just on myriad matters that get away from the key point of patient care.

MPs in the east of England came together and, by speaking to the CQC and providing evidence, we managed to stop the ambulance trust gaining foundation trust status, because of the issue of care. Politicians therefore can and should intervene when there is evidence of things going wrong, and not just accept the initial recommendation of Monitor.

I pay tribute to David Hill, chief executive of James Paget hospital. He had been chief executive of the hospital before and went elsewhere in the health care system. He came back and within a week I could see that he had made a difference in the attitude to care. A year on, I am delighted to report that all the warning notices have gone and that in the latest unannounced inspection it was given a clean bill of health. That is great news for the patients and great news for the staff. It is a reminder that being brave and being prepared to incur the wrath of people who assume one is attacking the NHS when one is actually trying to defend the NHS and patients, can be worth hile.

That leads me on to the matter of the difficult jobs we have to do. We have to remind all our governors and board members that they are there to represent the patients. They should not feel cowed. They should be tenacious in pursuing the outcomes that everybody wants in the NHS. These are not easy times—I appreciate that. Let us not have too much hand-wringing about how hard it is. We all know it is, but I believe that politicians of all parties are here to try to support the people. We will not do that by ducking the reality that we have to be accountable. That is true in this House if we let down our constituents, but it is also true for the members of boards who do not hold their chief executive to account and demand nothing but the best for their patients.