Accountability and Transparency in the NHS

Valerie Vaz Excerpts

Thursday 14th March 2013 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy) and to pay tribute to him for the dignified way in which he has represented his constituency during the Francis report.

I begin by thanking the Backbench Business Committee for securing this important debate. The NHS in England has a budget of £108 billion and employs 1.35 million people, with just under half of them clinically qualified, so it is right that accountability is at the centre of the NHS, for the people who work there, those who use it and those who fund it. I am sure that all my hon. Friends who have spoken and will be speaking in this debate do not see it as a chance to score political points or as background noise to denigrate an institution that was set up with the simple promise that is delivered every single day—that health care is free to everyone, irrespective of their ability to pay or of pre-existing conditions. It still operates as a service in which people are not judged on their illness but provided with a service.

I know that the debate is taking place against the background of the Francis report, but I wish to point hon. Members to a book that is about to come out—it is by Roger Taylor and called “God bless the NHS”. It was serialised in The Guardian last weekend. Roger Taylor says in the book:

“Paul Woodmansey was a senior doctor at Stafford throughout the period that things went wrong; He is mentioned by a number of patients for whom his department provided a haven of professional high quality care while standards in other wards collapsed.”

Let us not forget then that, even when a light is shone in a corner of the NHS where it is found to have failed the very people it was meant to help, there are areas of good practice.

Let us look at the background of this debate on accountability.

[Jeremy Lefroy]

I am sorry to interrupt the hon. Lady, but I would like to point out that the same Dr Woodmansey has been appointed as the new medical director of the Mid Staffs trust Stafford hospital. I welcome that, for the reasons that she has articulated.

--- Later in debate ---

[Valerie Vaz]

Let us look at what is going to happen in 18 days’ time when the Health And Social Care Act 2012 comes into force. I do not want to rerun the arguments about the Act, but let us look at what is to come. Let us look at the accountability of the structures under the Act. The NHS Commissioning Board becomes the conduit for everything, including the flow of money, and all the strategic decisions filter down. If anyone cares to look at the Department of Health website and the new structure, they will see a series of concentric circles. Parliament, the Department and the Secretary of State all appear to be in the outer circle, running round in circles. Where is the accountability in that?

I have to tell the Secretary of State—although I am pleased to see him here, this is a Back-Bench business debate—that section 75 regulations were signed off, under a negative resolution, by a Minister who is not accountable to the House. Section 75 says that everything has to be tendered except for technical reasons, or reasons of extreme urgency. That had to be changed to state that contracts can be tendered if the relevant body is satisfied that the services to which the contract related are capable of being provided only by that provider.

Regulation 10 previously said that commissioners may not engage in anti-competitive behaviour; otherwise, Monitor will be after them. Sorry, those are my words. That was changed to say that commissioners must not be anti-competitive unless it is in the interests of patients.

What of the future? I pay tribute to the right hon. Member for Charnwood (Mr Dorrell), who made an excellent speech. I want to draw attention to a report that our Select Committee produced on complaints and litigation in June 2011. I urge the Secretary of State, if he cares to listen, to read that report and consider all the recommendations. Even then, we called for all providers to have a duty of candour to patients. We also said that we found it striking that the Government did not mention complaints in the information revolution consultation and were surprised that they did not see how complaints information could help people see what is going on. My hon. Friend the Member for West Lancashire (Rosie Cooper), who is no longer in her place, was right to say that complaints can provide information about what needs to be put right.

Mr Deputy Speaker, I am not sure whether you are aware that the NHS litigation bill has now reached £1.3 billion. I urge the Secretary of State to look into the reasons why that is happening. We have to redress negligence, but there are other reasons why that bill is rising. There are remedies that do not involve money or changes in structures or reorganisations.

[John Pugh]

Does the hon. Lady acknowledge that that is what the NHS Redress Act 2006 was supposed to do? I am genuinely puzzled, and I hope that the Minister will resolve this puzzle for me, about how much of that Act has been formally enacted.

[Valerie Vaz]

I cannot answer that; I am not on the Front Bench.

We all agree that there is no place for gagging clauses if lessons are to be learned about patient care. I agree that the Government have made an important announcement today, but let me remind the Secretary of State that the NHS issued management directions in 1999 and 2004. I am concerned that the NHS still needs reminding about these gagging clauses. We must get away from a system in which whistleblowers are driven out of their jobs on spurious disciplinary issues. At Mid Staffs, doctors and nurses are under disciplinary reviews, but as yet I have not heard anything about whether managers will also be held to account.

Action plans that arise from complaints are a vital part of organisational learning, but they are only of value if they are followed through to implementation, and it was clear from evidence to us in the Select Committee that that did not happen at Mid Staffs.

Publication of complaints data must be obligatory for all care providers, including foundation trusts and private providers with NHS contracts. We must move away, as the hon. Member for Southport (John Pugh) said, from the blame and victim culture and reduce the emphasis on disciplinary procedures. We must put more emphasis on retraining and risk management.

We should enshrine accountability for patients at board level, making boards more diverse, not just comprising the usual suspects. Private providers, as my right hon. Friend the Member for Leigh (Andy Burnham) said, are not subject to FOI; they must be. The register of GPs’ interests must be open to clinical commissioning groups. It should not be up to the public to ask whether GPs have declared their interests. Every decision must be associated with a list of GPs’ interests.

I have spoken to the chief executive of the Royal Orthopaedic hospital, who said that he ensures that doctors, nurses and managers are all on an equal footing, which is an example of good practice. His phrase is that there should be “no gap between board and ward”. He puts his patient groups on the board, every ward gets rolling visits and board members even feed the patients.

In my own way, I have also been accountable and I have published on my website a table of all the complaints my constituents have come to me about so that they can see what sort of things are going on at the Manor hospital. The chief executive of the hospital is undertaking a patient survey and ensures that he looks at all the responses.

I hope that I have outlined some positive aspects as a way of moving forward and that we will continue to have an accountable, transparent and unique NHS that is the best in the world.