Francis Report

William Cash Excerpts

Wednesday 5th March 2014 Commons Chamber

[Mr William Cash (Stone) (Con)]

May I reiterate what my right hon. Friend has said about the absolute point-blank refusal, repeatedly and whenever I raised the question of an inquiry under the Inquiries Act 2005, to hold such an inquiry? The previous Government would not hold an inquiry; they totally refused to do so, which was an absolute disgrace. To his credit, the present Prime Minister listened to my arguments, and one of the first things he did when he came to government was set up an inquiry, which now has the capacity to transform the national health service.

[Mr Hunt]

We are about to hear from the shadow Health Secretary who will have the chance to put things right on that account. My hon. Friend the Member for Stone (Mr Cash) was extremely courageous, determined and persistent in campaigning for a public inquiry, and with the support of my predecessor and the Prime Minister, that is leading to the profound changes we are seeing today. We would all welcome the Labour party’s support for that.

I opened this debate by paying tribute to a few brave individuals who started a movement in England for safe, effective and compassionate care.

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[Andy Burnham]

It is interesting that Government Members do not like it, but this is the reality in the NHS right now, 12 months after the Francis report. Patient care is being compromised in the mental health care system. If the hon. Member for Mid Norfolk (George Freeman) does not think that that is relevant, let me quote Professor Sue Bailey, the President of the Royal College of Psychiatrists. She said that mental health units are

“heading for a Mid Staffs scandal”.

If that is not relevant, what is?

[Mr Cash]

Just to put the record straight and to give the shadow Secretary of State the opportunity to rectify something he was responsible for at the time, I accept that there was a Francis report before the inquiry under the Inquiries Act 2005 took place. In the light of the fact that he has himself acknowledged many of the recommendations of the Francis report, will he now accept that it was a grave mistake not to have a public inquiry under the 2005 Act on his watch that of his predecessors as Secretaries of State?

[Andy Burnham]

I am pleased that the hon. Gentleman has acknowledged that it was I who appointed Robert Francis to begin the process of an independent inquiry into what went wrong. I shall say more in a moment about what I did, why I did it, and why I stand by what I did, because in my view what I did was help to get to the truth while also helping Stafford hospital to recover.

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[Jeremy Lefroy]

I agree. The treatment of whistleblowers has been a disgrace, not just at Mid Staffs but in many other places. I have seen consultant contracts from way back that have prevented their raising issues even with their Members of Parliament, and I am glad to say that sort of thing is coming to an end. I want to try to focus as much as possible on the Francis report, however, as I believe there are many important lessons that all of us, including me, have to learn.

As the Health Committee has said, as a consequence of the issues I have outlined,

“a healthcare system established for public benefit and funded from public funds risks the undermining of its guarantees of safety and quality.”

It is my sincere hope that we never have the need for another inquiry of this nature. This should mark a watershed in the NHS—a time when patient safety and high-quality compassionate care is the rule, delivered through a positive and caring culture, underpinned by safety and quality management systems through our health service and backed by openness and accountability, which I am sure many Members will speak about later. It is thus that we can respect the memory of those who suffered at Stafford, but also in many other places across the UK, as the work of the right hon. Member for Cynon Valley (Ann Clwyd) has shown.

The Francis reports, and particularly the accounts of patients’ experiences, should be required reading for all medical and nursing students. I ask the Secretary of State to confirm that he will pursue that with Health Education England.

Robert Francis, for whom I have the greatest respect for the calm and understanding way in which he conducted the inquiry, made 290 recommendations, but I shall concentrate on his essential aims. He writes of fostering a common culture of putting the patient first. It is sad that he must write that, but it is necessary. However, before we rush to find fault with a service which has lost its way, let us just consider the society in which it operates, starting with ourselves. Can we honestly say that we always put our constituents’ interests first? What about others in the professional and business worlds? When self-interest and personal fulfilment are so often lauded, why is it that we expect the NHS to be so very different? Saying that is neither to excuse nor to lower the bar, but to understand how difficult it is in some circumstances to maintain that highest of standards. Ensuring that patients come first when dealing with several very ill and distressed folk, perhaps at 2 o’clock in the morning, takes more than just compassion. I am not downplaying compassion in any way—it is essential—but the underpinning of quality and safety systems carried through as second nature is also required. It means ensuring that the leadership is on call to provide extra help as soon as it is needed. It demands the strength to speak out for what is not acceptable and an openness to admit when there are problems. Without the systems and standards, the supportive leadership, the strength and the openness, not even an angel can always put patients first, much as they would wish to.

There has been much debate about staffing levels, and rightly so. Although the problems at Stafford went far beyond numbers, there is no doubt that cuts contributed to them. When I was first selected as parliamentary candidate in 2006, the trust had a £10 million deficit. It wanted to achieve foundation trust status and needed to balance its books, and part of its solution was to reduce the number of nurses. I should have questioned that, as should others, but we accepted the trust’s assurances that it would not harm patient care. I say to all right hon. and hon. Members that one thing that must come out of this report is that each of us must be emboldened to challenge our local trusts when they make statements such as, “This won’t harm patient care”, despite their cutting 100 or more nurses. The approach to staffing management and data publication used at Salford Royal NHS Foundation Trust has been held up as an example of good practice in staffing by the Health Committee and the Secretary of State, so let us act and adopt it everywhere.

I recall that when I was first elected to this House, I was shocked at the tone and content of some of the responses by the NHS to complaints. Not only did they take several months to arrive, but they were sometimes complacent, and they certainly lacked compassion and understanding. That has, for the most part, changed considerably for the better—it certainly has in Stafford. The overwhelming message I receive from my constituents who need to complain is that they are not interested in compensation, but they are interested in a better NHS for everybody. So let us approach the complaints system from their premise, not that of lawyers. That is the responsibility of the chief executive, who should review all complaints, and personally read and sign all response letters. The Secretary of State responds to several complaints each week personally and in this, as in many other ways, he sets the example.

Although I am encouraged by the progress made in treating complaints, I am less confident about accountability.

[Mr Cash]

Does my hon. Friend accept that it is clearly stated in the prime ministerial guidelines of 2005 that when somebody writes to a Minister who has responsibility, including the Secretary of State, the relevant Member of Parliament is entitled to receive a personal letter that comprehensively and efficiently deals with the question at issue? Does my hon. Friend also agree that, regrettably, that did not happen in all instances when matters were raised with regard to Stafford hospital?

[Jeremy Lefroy]

I thank my hon. Friend for that intervention and for all the work he has done on this issue. It is salutary for all of us to remember that when we get such a letter it often represents probably another 10 people who did not write to complain because they do not want to affect the NHS. We should treat each letter of complaint as being of immense importance.

I said that I am less confident about accountability, so let me say why. This is not just a question of the resignation of executives within a trust or the NHS when things go badly wrong, although it remains astonishing to me that no one has had the courage to do this given that the failings in Stafford were so clearly systemic; it also concerns the approach of the professional bodies representing nursing and clinical staff. The Francis inquiry saw evidence of poor co-operation with the General Medical Council from other organisations, including royal colleges, even though serious matters of fitness to practise and patient safety were involved; they almost put the practitioners above the patients. Those representing the medical and nursing professions are accountable to the public first and foremost. The best way of maintaining public confidence in their professions is to ensure that they treat their members who are not fit to practise in a firm, fair and swift way; cases of doctors or others being suspended for months or even years are too frequent.

Before I discuss Stafford specifically, may I just make a few remarks about hospital standardised mortality ratios? The Francis report states that Professor Jarman

“made it clear that it is not possible to calculate the exact number of deaths that would have been avoidable, nor to identify avoidable incidents…The statistics can only be signposts to areas for further inquiry.”

I urge all those who handle HSMRs to do so with care. They are extremely important as guidelines, and it was absolutely right that they were the first statistics that showed up the need for the Healthcare Commission inquiry, but to extrapolate numbers from them can be difficult and the evidence does not necessarily bear it. We have seen examples of that happen.

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[Mr Burley]

The right hon. Gentleman asks a number of questions. I am still not clear about his position and whether he thinks that the public inquiry was the right decision or not. The inquiry led to recommendations and the improvements we have seen. To answer his question about whether “the TSA process was worth it”—that was the phrase he used—as we speak in the Chamber today, my local hospital is 50% empty. Cannock Chase hospital was run down by the management of Mid Staffs to near closure, and half of it lies empty. Any building that is half empty has a sword of Damocles hanging over it, and no one from the Opposition complained locally as services were slowly stripped out by stealth over the past 10 years. As a result of the TSA process, Royal Wolverhampton Hospitals NHS Trust will take over running of Cannock hospital, increase utilisation from 50% to 100%, and invest £20 million in refurbishing it. That shows that the TSA process has been fantastic from a Cannock Chase perspective, even though it has been a stressful and drawn-out process.

I praise my hon. Friend the Member for Stafford for his tireless work on this issue and for his technical and clinical knowledge of local services, which is second to none in the House. His campaigning has led us a long way from the point at which A and E, maternity and paediatrics would all be closed, which is a hell of a legacy of public service to the people of Stafford who, I am sure, will return him at the next election for a second term—one which I hope is not dominated by the issue of Stafford hospital, as his first term has been.

As we know, the Government introduced measures in the Care Bill as their legislative response to the Francis inquiry. Those measures include the introduction of Ofsted-style ratings for hospitals and care homes, creating a single regime to deal with financial and care failures at NHS hospitals, introducing a duty of candour, and making it a criminal offence for care providers to give false and misleading information about their performance. It may surprise many that those measures do not already exist. Local parents in my constituency send their children to schools in Cannock that have an Ofsted rating, and they can speak to teachers about any documented problems in the school. Those same parents take their elderly relatives to Stafford hospital and are surprised when they receive appalling care—indeed, some even die suddenly—because there is simply no clear ranking of how that hospital is performing as there is for their children’s school.

Worse still, nursing management and staff had actively been covering up the problems. As we have seen locally, the events at Mid Staffs clearly demonstrate that a culture had been allowed to develop in the NHS in which defensiveness and secrecy were put ahead of patient care. Think about that for a moment: they were put ahead of patient care. In the 21st century, is that not a damning indictment of an institution that was set up to improve the health of its people, but has been encouraged over the years to protect itself and its reputation more than the people it exists to serve? I think that all Members should reflect on that before rushing to defend the reputation of the NHS. We should remember why the NHS exists: to serve the patients, not itself or any political party.

In the time available, I want to talk about two things: prioritising the patient experience and the TSA process. Before doing so, I think that it is worth remembering how we got to this point today. Macmillan Cancer Support’s briefing for this debate, which the hon. Member for Stoke-on-Trent South (Robert Flello) has already quoted, gets it spot on:

“The failure at Mid Staffordshire NHS Foundation Trust to put patients and their priorities at the centre of their work was a key finding from Robert Francis’ report… In particular, the report found that the trust prioritised its finances and Foundation Trust application over providing a high quality of care that put patients first.”

To quote a source that we on the Government side of the House all read regularly, the World Socialist Web Site:

“Under the 1997-2010 Labour government, Stafford was pressured to transform into a Foundation Trust—an initiative aimed at making hospitals semi-independent of the Department of Health by ‘freeing’ them to find private funding sources. In the process, £10 million was cut from the Trust’s budget and 150 jobs lost, leading to nursing staff shortages, overwork and the inability to provide a high-quality service to vulnerable patients. Any excess deaths at the hospital must be attributed to this shift.”

[Mr Cash]

Does my hon. Friend recall—it might be difficult for him as he was not a Member of the House at the time, but perhaps he can refer to previous documents—that when the meeting on granting trust status took place, the then head of Monitor, William Moyes, asked the trust a series of 48 questions, of which 39 were about finance? In other words, that was the priority at the time. That is where things were going badly wrong.

[Mr Burley]

I am grateful to my hon. Friend, who has a longer history in this House than I do, and indeed a longer future. He is right that finance was put far above patient care. People in Staffordshire are still astonished that the trust was ever granted FT status. I asked Robert Francis himself, and he said that he had no idea how, in the climate my hon. Friend has just described, that failing trust, which was bankrupt at the time, was able to shed staff for no clinical reason at all in order to achieve FT status, and that FT status was granted while all those problems were lurking beneath the surface. I would welcome any intervention from an Opposition Member to say why that was signed off.

The Conservatives are not alone in saying that Labour created a culture of targets in the NHS that led to thousands of unnecessary deaths at Mid Staffordshire hospital. It is also being said by the World Socialist Web Site and by independent charities such as Macmillan Cancer Support, which says that the trust prioritised its FT application over providing high-quality care that put patients first. Let us be clear what that means. The management of the Mid Staffs trust shed 150 nurses, many of them my constituents; it sacked them from their jobs, which were clearly vital, given the appalling care that followed, simply to hit financial targets. Those financial targets were not due to budget constraints—to be fair to the previous Labour Government, they did not reduce the NHS budget in Staffordshire. The job cuts were made deliberately to meet an aspirational organisational form. What a strange position to arrive at in the 21st century, where management think that it is acceptable to shed necessary nursing jobs simply to achieve an organisational form, as though that is in some way more important than serving the health needs of patients.

The Francis report is so important because it states for the first time: that the patient, not a foundation trust application, should come first; that there should be a statutory duty of candour, rather than a culture of cover-up; that feedback from patients should be valued and listened to, not ignored, as was the case in Stafford; and that hospitals should be rated, as Ofsted rates schools, and publicly assessed so that patients can make informed choices about their care.

The figures show that NHS care has changed for the better just one year on from the Francis inquiry. The 14 hospitals now in special measures are slowly being turned around, with 650 extra nurses and nursing assistants hired, strong leaders installed and 49 board-level managers replaced. Some 2,400 extra hospital nurses have been hired. Since May 2010, 3,300 more nurses and 6,000 more clinical staff are working on NHS hospital wards overall and—this is the crucial figure—nearly 1.6 million patients have given direct feedback on what they thought about their treatment through the friends and family test.

There is clearly a shift of priorities going on within the NHS, which is to be welcomed, but it would never have happened were it not for the Francis inquiry—an inquiry, of course, that would never have happened under the previous Government. I repeat my earlier point about the importance of not protecting the reputation of the NHS as an institution, but above all else focusing on the care of the patients that it exists to serve.

[Joan Walley (Stoke-on-Trent North) (Lab)]

This debate, which is taking place 12 months after the publication of the Francis report, is long overdue and desperately needed.

[Mr Cash]

I endorse what the hon. Lady says. I think that I had to call 15 times for the report to be debated.

[Joan Walley]

I think that there has been an extraordinary degree of cross-party support from all Staffordshire MPs for efforts to get the matter on the agenda. When we look at the initial inquiry called by the Labour Government, its extension and then its translation into a full public inquiry by the current Government, and when we consider how quickly we as parliamentarians need to ensure that we hold the Government to account, we must recognise, as the hon. Gentleman says, that it has taken an extraordinary amount of time to get this debate.

At the heart of this debate is the need not only to discuss something that affects the whole country and Wales, as we heard from my right hon. Friend the Member for Cynon Valley (Ann Clwyd), but to see what lessons the three inquiries have to teach us. One of the Francis report’s main recommendations is that it is also for Members of Parliament to question ourselves on how we hold our own trust boards to account. In a way, we need the ammunition to be able to do that. I know that the previous Member for Stafford genuinely tried to get answers on what was happening at the time from the then trust board, but those answers were not forthcoming.

[Joan Walley]

That encapsulates the problem of Members of Parliament trying to get to the bottom of what is happening but being denied the information. I think that the main thrust of the report is a call for transparency and openness, for freedom of information, so that we can get informed decisions being made at local trust board level on the future direction of policy. The issue is how that is constrained by the available finances. One regret is that the finances do not come into the Francis report to the extent they might. We know that at the local level those in charge of health services are trying to ensure that they deliver a service within the financial constraints.

[Mr Cash]

Does the hon. Lady accept that one great problem that beset the whole Stafford tragedy was the fact that it was integrally affected by a target-based culture? That was one of the main problems, which I hope we are now getting away from.

[Joan Walley]

It may surprise the hon. Gentleman to know that I agree with him, and that the target culture has a lot to answer for. We have moved on from that now, and we are looking at how to achieve the best possible health care within the available resources. As my right hon. Friend the Member for Leigh (Andy Burnham) said, it is important to have integration, cross-cutting services and collaboration. We must move on from the target culture to look at the best possible way to achieve high standards of service throughout the country and stand-alone services in localities.

I want to put on the record my concern that lives were destroyed and that many people and their families were severely affected by what happened as a result of the systemic failures in the Mid Staffordshire NHS Foundation Trust, and specifically at Stafford hospital. There are many lessons to be learned, and we owe it to them to ensure that we move on and get the right hospital services.

For the record, may I say that at the time I supported the call for a public inquiry? I say that from these Benches.

Whatever the mechanism, the heart of the matter is that we must learn the lessons and move forward. It is right to debate the broader issues, values and culture of the NHS. We must recognise that an integral part of that is the procedures to deal with a failing hospital. As we assess progress on the implementation of the Francis report, it is vital to hold the Government to account for their handling of the parallel process—the trust special administrator’s report. It is essential for those of us in Staffordshire to have clarity from the Secretary of State—I am sorry he is not in his place—on future arrangements for health care in Stafford. That is what most concerns me and I shall concentrate my comments on that.

Reference has been made to how fit for purpose the trust special administration process is. Is it just about finances, or is it about the broader health care that should be provided? Changes are being introduced in the Care Bill, which will come to the House on Monday. The Government must address how stuck we are with the TSA and the TSA reports, and whether they are broad enough to deal with breakdown and failure in individual hospitals. Obtaining a resolution on how current hospital services in Staffordshire are being taken forward is urgent. That is part and parcel of how we take forward the lessons that the Francis report identified.

For me, the most important paragraph in the Francis report’s terms of reference is identifying

“the lessons to be drawn from that examination as to how in the future the NHS and the bodies which regulate it can ensure that failing and potentially failing hospitals or their services are identified as soon as is practicable”.

On the trust special administrators, we should aim to identify what needs to be done in advance of a hospital failing. In Staffordshire, we are stuck with a procedure. A report was carried out and sent to Monitor, and there was public consultation, which took place only in the Mid Staffordshire area. It is a great concern that when a hospital—in our case, the University Hospital of North Staffordshire—makes a proposal to rescue some of Mid Staffordshire’s services, there has been no corresponding consultation in that area about the impact of the changed configuration of health services in north Staffordshire. That is a real failing and the Government should take it on board.

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[Mr William Cash (Stone) (Con)]

It is quite difficult at this stage in the saga—the tragedy—of Stafford hospital to recall how it all came about and the difficulties that those of us who experienced it had to endure, the patients and the victims in particular. There was complete and total resistance—indeed, worse than that, a granite-like refusal—to having a proper look at what was going on. It would take much longer than I have available this afternoon to explain exactly the tooth and nail battle that I had to engage in to get the inquiry in the first place under the Inquiries Act 2005.

In a previous incarnation as the Member for Stafford, I had already had Stafford hospital in my constituency for 14 years, from the date of a by-election some 30 years ago in May 1984. I experienced a tragedy in Stafford hospital during that time with legionnaire’s disease, and I came to this House and asked the then Prime Minister, the late Margaret Thatcher, whether she would give us a full public inquiry—equivalent to one under the provisions of the 2005 Act. I did that because I knew it was impossible to get to the root of what was going on unless we had such forensic evidence, with cross-examination on oath and all the other—not paraphernalia, but necessary ingredients as part of the process, to ensure that we could bring to light what was required.

I was absolutely astonished that successive Secretaries of State completely refused, point-blank, to have such an inquiry in the case of Mid Staffordshire. I have to put it on record that the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who is not even in the House this afternoon—perhaps he has some excuse or justification—was the Secretary of State during a lot of the time in question. Patricia Hewitt was also Secretary of State for part of the time when serious problems were going on. The right hon. Member for Kingston upon Hull West and Hessle refused to have a public inquiry. The right hon. Member for Leigh (Andy Burnham) also refused to have an inquiry of the 2005 Act type. Although it is certainly true that he agreed to a Francis inquiry, and that there was also the Alberti report, the Colin-Thomé report and one or two other investigative exercises, none of them had the right ingredients to give them the capacity to get to the root of what was going on.

I am delighted with what my right hon. Friend the Secretary of State has done since then. I was extremely glad that, when we were in opposition, I was able to overcome some resistance to a 2005 Act inquiry from shadow Ministers. The current Prime Minister, then the Leader of the Opposition, listened to the arguments that I and others made and agreed to have a full 2005 Act inquiry, because he understood how important it was, as the Secretary of State does. The consequence has been to enable us to make changes throughout the entire health service that, as Opposition Members have acknowledged today, have enabled us in Staffordshire to be a pathfinder for solving some, if not all, of the problems presented in the health service.

The work of Cure the NHS has included that of my constituent Deborah Hazeldine. She does not get a great deal of publicity, but she was the one who came to me in my office in December 2008, with Julie Bailey, and explained that they were getting nowhere with the complaints and concerns that they were expressing. They asked what could be done about it, and I explained to them that if they did certain things, I thought we would be able to get a campaign moving of the kind that would be needed to get a 2005 Act inquiry. I pay tribute to them, and to Ken Lownds, who has been a tower of strength. He is a man of enormous integrity, knowledge, skill and commitment. I pay tribute to him for what he did to ensure that we got the inquiry, for the evidence that he gave to it and for his continual determined input into improving the health service since the Francis report was produced.

I am delighted that the Francis report came out as it did. It had, I believe, 299 recommendations, and it has been immensely important to the future of the health service. I do not need to go into all the details, but I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my next-door neighbour, with whom I worked closely from the beginning. He committed himself to a 2005 Act inquiry when he was in what could be described as the delicate situation of being about to become the Member of Parliament for Stafford but not entirely certain that it would happen. He did it, and he was right, and I pay tribute to him for everything that he has done since.

[Mr Jeremy Hunt]

I am grateful to my hon. Friend for his generous comments. While he is paying tribute to people who have played an important role in getting us to where we are, may I add my thanks to Deborah Hazeldine, and also to Ken Lownds, who was the first person who really talked to me about the important concept of zero-harm health care? I know my hon. Friend will not mind if I also mention campaigners from other hospitals, such as James Titcombe in the case of Morecambe Bay, who have also played an extremely important role in the debate.

[Mr Cash]

I am extremely glad that my right hon. Friend has made that point. The zero-harm policy is so important, and I am grateful for that specific intervention. It will make Ken Lownds’s day. I also pay tribute to people all over the country who have taken up the message and sought to improve the health service in their areas. This has turned into a national campaign, and the Secretary of State deserves great credit for the way he has helped to co-ordinate it.

I was, and remain, completely amazed that the right hon. Member for Kingston upon Hull West and Hessle, and Patricia Hewitt, were not even asked to give evidence to the inquiry. I still find that completely staggering to my way of thinking. I know that the right hon. Member for Leigh was asked to give evidence, and did, but I place the point on the record because I found it extraordinarily difficult to understand then, and I still do now.

I have constantly and repeatedly called for the resignation of Sir David Nicholson. I know he is retiring soon and that that resignation will not happen, but I repeat my concern, as I did in evidence to the inquiry, because the whole target-based policy was very much tied up with his approach to these matters. Indeed, in the last of, I think, about 600 paragraphs of his evidence to the inquiry, he referred in the last two lines to the fact that the Member of Parliament for Stone, Mr Bill Cash, had raised the question of his involvement in target-based policies. He said that there were arguments on both sides of the equation regarding target-based policies, but I do not agree with that. I do not think target-based policies were the right way to go, and I am glad that the hon. Member for Stoke-on-Trent North (Joan Walley) agreed with me. As I pointed out in my evidence to the inquiry, such policies had a terrible effect on the attitude of Monitor regarding the financing issues that provided 39 of the 45 or so questions put by William Moyes to the foundation trust when it received its approbation—something it should never, ever, have got. I say to the right hon. Member for Leigh that through the mechanism of the Department—I cannot point precisely to chapter and verse—the fact that the foundation trust got such status was also the product of a misjudgment by the Government at the time.

I have already referred to correspondence in an intervention, but in the prime ministerial guidelines of 2005, under the previous Government, it was clearly stated that when Members of Parliament write to Secretaries of State and other senior Ministers, they are entitled to receive a full, comprehensive response—personally—from that Minister. I found that wanting during this process. I was glad to note, however, that in the course of evidence to the inquiry, the situation moved from what appeared to be resistance to going down that route, to an acceptance that—to paraphrase from the evidence given by the chief executive of the Department of Health—from now on, when a Member of Parliament writes with a letter from a constituent, and explains that things have not gone properly regarding that constituent’s health problems, there is a mechanism to ensure that the issue is dealt with properly. I will not have to go into all that today, because it has been rectified.

In my evidence, I also raised the issue of whistleblowing. I also tabled amendments to the then health legislation, calling for the repudiation of gagging clauses and providing that any chief executive who endorsed them and got his legal advisers to agree to them should be dismissed. That is another area that has been dealt with, so we are making progress. I very much endorse the views expressed on both sides of the House about having unity across the Floor of the House, as far as we can achieve it, on the central principles.

I agree with what my hon. Friend the Member for Stafford said about the issue, although I have a difference, not of opinion but of emphasis, because my constituency is very rural, and access to the artery of the M6 is not easy. It can be difficult to reach, especially at night, because it can be a long way through small rural lanes, to access the M6 and the University hospital of North Staffordshire or hospitals in Wolverhampton. That is my caveat on that.

We have made enormous progress. I am glad that the Mid Staffs foundation trust is being dissolved, and that—as my hon. Friend the Member for Stafford said—the Prime Minister, at a recent Prime Minister’s questions, backed plans, in as many words, for consultant-led maternity to continue at Stafford hospitals. That service, plus paediatric services, critical care and a 24-hour emergency service, is necessary for constituents in Stone and the rest of Staffordshire. I will work with my hon. Friend to ensure that that is delivered.

[Joan Walley]

Does the hon. Gentleman agree that there could be some inconsistency between those two conflicting things unless we get immediate clarity from the Government about the time scale in which they will be taken forward?

[Mr Cash]

That point will have been taken on board by the Secretary of State, who is in his place. One of the good things about the present Secretary of State is that he does listen. He takes things on board and follows them up. Some Secretaries of State do not always do that—they nod, but they do not necessarily do that.

[Joan Walley]

In that case, I wonder whether the hon. Gentleman would like to invite the Secretary of State to come to the Dispatch Box and tell us when the timing will be resolved, because we have this continuing uncertainty.

[Mr Cash]

I shall not engage in a vicarious ping-pong match with the hon. Lady. The point has been made and taken—I see that the Secretary of State is nodding—and I know that other people wish to speak, so I shall try to bring my remarks to a close.

[Paul Farrelly]

I pay tribute to the hon. Gentleman for his persistence, and to the work of the hon. Member for Stafford (Jeremy Lefroy), who was elected only in 2010; this has been the dominating subject of his time in the House.

As well as concerns about the length and cost of the administration process, the University hospital of North Staffordshire has raised concerns that it has not been able to do its own full due diligence at the same time. We cannot quite put our finger on whether that has been because of the administration process or concerns about competition. Does the hon. Gentleman agree that when such situations arise in future—and hopefully that will be rarely—we will need to speed things up in a collaborative way and that competition issues will not surface?

[Mr Cash]

I am concerned that there should be a maximum degree of co-operation and collaboration, and perceptible unity has been demonstrated across the Floor of the House on the question of achieving co-operation in the national interest. It is extremely good that that is happening. This is not just about us as MPs; this is much, much more important. This is about victims, patient care, zero harm and people having confidence in the health service. It is absolutely essential that across the Floor of the House we achieve the maximum possible amount of collaboration on this matter.

I wrote to Mr Francis in July 2009 to ask for an inquiry under the 2005 Act, and expressed my concerns regarding the Healthcare Commission investigation at that time. In fact, in that January I had submitted a list of questions, which I had put together with Cure the NHS, Ken Lownds, Julie Bailey and Deborah Hazeldine, to ask what the Healthcare Commission was going to do by way of a report. The HCC reported in March and I hope that our intervention at that point was helpful. If those questions had not been asked, I am not quite sure what the HCC would have said. I was concerned that the reviews by Dr Laker, Professor Alberti and David Colin-Thomé were not as independent as I felt they should be. That is what led me to step up my campaign for the 2005 Act inquiry, for the reasons I gave at the beginning of my remarks.

I pay tribute to all those, from all parts of the House, who have helped to address the matters with which the Francis report has so ably dealt. I remain concerned that some people who should have given evidence were not called to do so, but we now have the report. At long last, after calling for a debate on, I think, 15 occasions, we are holding it. I am absolutely delighted that we are making progress nationally to improve the national health service. Long may it continue.