Accountability and Transparency in the NHS

Tracey Crouch Excerpts

Thursday 14th March 2013 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this very interesting debate, which has covered lots of issues to do with accountability and transparency, not only at Mid Staffordshire but throughout the entire country. It is clear from the speeches by the right hon. Member for Cynon Valley (Ann Clwyd) and my hon. Friend the Member for Wycombe (Steve Baker) that these concerns go beyond the appalling events at Mid Staffs. My own constituents need reassuring about their patient care, the quality of the information they are receiving and, unfortunately, the mortality rates at Medway Maritime hospital. Like other hospitals, it is now under investigation, and we await the outcome with interest.

It often takes a very long time for the truth about these matters to be completely uncovered. In the past, the quality of patient care has, in many respects, been secondary to the hospital meeting its targets. That is a shame, and it is part of the culture that we need to change. I do not want to believe that there is a culture of cover-up in the NHS. Like my hon. Friend the Member for Totnes (Dr Wollaston), I think that all those who work in the NHS—the nurses, the doctors and the consultants—do a brilliant job in delivering good quality care and the best patient outcomes. Unfortunately, that was not the case at Mid Staffs, and concerns about quality of care and mortality rates are spreading. As I have said, constituents are now concerned about the care they receive at the Medway Maritime hospital.

The trust is always incredibly good at responding to my questions, whether they be about what I consider to be the high use of the Liverpool care pathway at the hospital, constituent complaints, dementia care or specific patient services. However, I fundamentally believe that if a constituent has to involve an MP in a complaint, the system has failed. There is a growing perception that if someone complains, it is their fault and they are in the wrong, while the hospital paints itself as the victim of the complaint rather than the other way around. That is wrong.

The Medway Maritime hospital is under investigation for higher than expected hospital standardised mortality rates, and there is currently a specific outlier alert on septicaemia. Worryingly, this is not the first time this has happened. Discrepancies in coding were highlighted way back in 2008 with the discovery that 8% of deaths were being recorded as end-of-life care when the proportion should have been 37%. Adjusting the mortality index to exclude those deaths reduced the hospital’s score by more than a third. A clear manipulation and distortion of the information only served to damage the best outcomes and services for the patients. I hope that that will not happen again. However, as an outsider it appears to me that the complexity of coding is part of the problem with the lack of transparency.

A culture of bullying and its suppression within the NHS has been mentioned. The latest staff survey at the Medway Maritime hospital shows that there is still a perception that bullying is widespread. If we want to improve standards in patient care—which is a key aspiration for the newly restructured NHS—that has to be one of the most important issues to address. I welcome today’s announcement by the Secretary of State, but may I make a practical suggestion that was put to me by a GP this morning? One of the problems with the system for complaints is that they stay within the hospital—they go up to the management board and do not really go beyond it. Instead, complaints could be delivered on a quarterly basis to the new clinical commissioning groups, which would enable people outside the hospital structures to look at potential trends and patterns of poor quality, and at whether there are concerns about specific consultants. We could end up taking the responsibility from the hospital, having the outsider look in, and making more practical changes.

Greater transparency in the NHS is not just about honesty and accountability, but about better communication. As the most recent ombudsman report highlighted, the common pitfalls are also the result of equivocal language over care, the use of technical language and the failure of insincere apologies. We need to learn the lessons of the Francis report; patients from those families who use my local NHS services deserve nothing less.