Cass Review
William Cash Excerpts(1 week, 5 days ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Victoria Atkins
True leadership is not just about being careful with the words we use. I will not recite the many words that other Labour Members have used about trans issues. They say, for example, that it is factually inaccurate to say that only women have a cervix—[Interruption.] I am not naming them, but that seems an extraordinary things for a Labour Member to say. [Interruption.] They do not like to hear their words repeated back to them, but I will resist that temptation and instead focus on the application of policy.
Trans prisoners, including those who are fully intact and have been convicted of serious sexual offences, are demanding to be held in prisons that match their chosen gender. This Government, including me and many of my predecessors as Prisons Minister, set clear rules to ensure that situations such as the Karen White case are not repeated, so it was very troubling that Opposition Members did not appear to have the same concerns when it came to the placing of a trans double rapist, Isla Bryson, in Scotland. [Interruption.] I am being told that it is not true but, if Opposition Members want to factcheck, apparently it was the deputy leader of the Labour party who said that it does not matter.
Sir William Cash (Stone) (Con)
Although I would like to believe that many of these problems will be resolved by guidance and by changing the administrative rules, and things of that kind, I fear that the real problem is much deeper. It is about the manner in which, over the last generation, we have introduced legislation that has facilitated these arrangements. I am glad that the Government have passed the Online Safety Act 2023 to deal with the platforms on which a lot of this stuff has been spuriously put out by people with absolutely no moral compass.
I thank the Secretary of State for what she has said this afternoon, and for the robust and extremely effective manner in which she has said it, but please do not believe that this will be resolved just by changes to administrative rules. This is about a moral compass and telling the truth. The legislation, whether it is the Equality Act 2010, human rights law or whatever else it might be, will need to be changed.
Madam Deputy Speaker (Dame Rosie Winterton)
Order. I want to get everyone in, but we really cannot have mini-speeches. We need questions that the Secretary of State can answer briefly.
Oral Answers to Questions
William Cash Excerpts(4 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Matt Hancock
I agree with most of what the hon. Member said and the starting point in particular—that the gaps in healthy life expectancy are far too big. She will have heard me articulate from this Dispatch Box how important it is that we close those gaps. The news out this week of lower mortality in 2019 was good news that she ought to welcome, but it certainly does not mean that the campaign to close the gap in healthy life expectancy is over. There is far more to come.
Sir William Cash (Stone) (Con)
Coronavirus has a bearing on life expectancy and I have a particular concern in relation to GPs in surgeries in my constituency. A world-leader on the transmission of infections raised with me a vital question, which is the provision of protective suits and training. At the moment, I am told that they are not being given to GPs, but exclusively to hospital staff. Will the Secretary of State please look into that and do something about it?
Matt Hancock
I am right across this issue. My hon. Friend is right to raise it, but I can reassure him fully that we have now rolled out personal protective equipment to two-thirds of primary care and the rest of it is in progress. We will absolutely address this issue. It is quite right that we did. We wanted to get the timing of the roll-out right so that the equipment is there should the epidemic hit in a very large way. We have to make sure we protect our health staff.
Listeria: Contaminated Sandwiches
William Cash Excerpts(4 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Matt Hancock
The shadow Secretary of State raises important questions, and I will try to address them all. Ultimately, I strongly agree with him that this is about standards of care. People deserve to be able to trust that the food they eat and are given in hospital is safe and, indeed, nutritious and good for their health—that is an important part of this too. Clearly, the most acute aspect of what we are discussing is safety and the lack of listeria in food, but it is part of a much bigger picture, which is why we are having a root-and-branch review.
The hon. Gentleman asked about the hospital food plan, which NHS Improvement has been leading. The review will be wider than, but will encompass, some of the existing work that is ongoing. It is about not only how food is procured by hospitals, but the quality of food. Work on the national standards in hospital food is important. It has been ongoing for several years and will come to fruition very soon. More broadly, dozens of hospital trusts have brought their catering in-house and found that they get better quality food that is more likely to be locally produced and is better value for money. We will be examining that model closely, because I am very attracted to it, and it has the potential to reduce the risk of safety concerns such as this.
The hon. Gentleman asked about timings. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy), was made aware of this outbreak on 4 June. I was informed on 6 June, and we published the details of the outbreak on 7 June.
Before that, Public Health England very swiftly identified that there was a link between these particular listeria outbreaks. It is only because of recent advances in genomic medicine and testing that we could work out—that Public Health England could work out—that the outbreak in Liverpool and the outbreak in Manchester were connected, and therefore identify that the source was outside those hospitals, rather than inside the hospitals, and that is what then identified that this was from the food source. The truth is that there are just over 150 listeria cases a year. It is a notifiable disease, so we are confident that we are properly notified of the various cases. Frankly, it was cutting-edge work by Public Health England that allowed us to connect these different cases and work out that a single source was causing these deaths.
The hon. Gentleman mentioned the 43 trusts that we know bought from the Good Food Chain. We have of course been in contact with all hospital trusts, whether or not they bought from this individual company, to try to make sure that we have confidence in their supplies. The Good Food Chain has confirmed that it has followed advice and has disposed of all products. That is what the Good Food Chain company has said to us, but we are of course reconfirming that with the trusts because we want to get this right.
Finally, the hon. Gentleman asked about investment in food and catering facilities. The truth is that it is important to have the best-quality food in hospitals. I am completely open to upgrading hospital equipment if that is what is necessary, and if it provides value for money. I have been struck by the number of hospital chief executives who have said that from the point of view of patient satisfaction, staff morale, and nutrition and the quality of food, bringing such food supplies in-house is the best thing they have done.
Sir William Cash (Stone) (Con)
The Secretary of State will be aware that in my constituency of Stone, where the Good Food Chain is situated, there is obviously very deep concern, not least because we had the horrendous Mid Staffs hospital crisis. I had to campaign on that against the Labour Government’s refusal to give a full public inquiry, which our Government did give.
Having said that, is it not the case that the Good Food Chain is only responsible for the products that the patients consumed, and that the bacteria came from another company, which I am given to understand is called North Country Cooked Meats in Salford? I do commend Public Health England and the Secretary of State for the rapid way in which they identified the connections between these different places. Whereas it is absolutely essential that we have the root and branch review the Secretary of State has provided, is it not also the case that while the companies concerned will have to accept responsibility as far as it falls on them, at the same time there are really important reasons to identify exactly what did happen—where the food was contaminated, how it was contaminated—and then to exonerate the Good Food Chain, if in fact that is the case, because it is very unfair for companies to be caught up in something when it was not entirely their fault?
Matt Hancock
My right hon. Friend—[Interruption.] Not yet. My hon. Friend rightly raises the question of the supply chain, and it is true that the food in question came from North Country Cooked Meats. In turn, we are trying to identify the suppliers to North Country Cooked Meats to get to the real root of this outbreak. He is quite right to identify that this is a supply chain issue, and that there is a complex supply chain in operation.
I join my hon. Friend in commending the work of Public Health England. Within days, it spotted the links between individual cases and, from a local incident, made this into a national incident. At the appropriate moment, it raised the issue with the chief medical officer and with Ministers in the Department, and we could then explain the problem to the public. Its work has identified the problem, and undoubtedly it has potentially saved lives.
Health Services in Staffordshire
William Cash Excerpts(8 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jeremy Lefroy
I thank my hon. Friend. She makes a point that I think will be echoed by other hon. Members in the area.
The reason given for the potential closure of the community beds was that more care would be provided at home, but how precisely will that be done? I have to declare an interest in that my wife works as a GP in Stoke-on-Trent. From what I hear, community nursing teams sometimes have difficulty in managing the workloads they have at the moment, so where will the extra capacity come from? Surely it would be more sensible, before those beds disappear—if indeed they are scheduled to disappear—to ensure that the extra community nurses are in place and to show that there is a clear reduction in the need for such beds. I urge the Minister to question any proposed reduction in community beds—even if it is not of the order mentioned in the press last week—at a time when they seem to be most in need.
I will now turn to acute services in general. The University Hospitals of the North Midlands Trust has recently announced the closure of in-patient oncology and haematology at the County hospital. In future, there will be outpatient chemotherapy treatment, but in-patients will be seen in the Royal Stoke hospital. This move was not dealt with in any detail during the public consultation on the proposals of the trust special administrator, nor was it mentioned by the NHS in its information about the changes in services provided to my constituents or to those of my hon. Friends the Members for Cannock Chase (Amanda Milling) and for Stone (Sir William Cash), and my right hon. Friend the Member for South Staffordshire (Gavin Williamson) who are affected.
From a visit to a patient on the oncology unit at the County hospital last week, it was clear to me that the service was not only very busy, but greatly appreciated. Constituents have written to me saying how important it was to have the unit relatively close, so that they could be with their family through stays which were very difficult and often lengthy. Why move what is appreciated and working well? I understand that there are staffing problems, but surely those could be tackled. I ask the Minister to look at this again.
Sir William Cash (Stone) (Con)
Does my hon. Friend welcome the statement made by the Secretary of State for Health the day before yesterday regarding the question of agencies and the absolute necessity to make sure they do not rip off the health service? May I also congratulate him not only on his splendid victory, but on the fact that he has just collected the Act of Parliament that he so successfully piloted last year?
Jeremy Lefroy
I thank my hon. Friend. He has been a huge support in all these matters, which have at times been extremely difficult. He is absolutely right. I have come across cases of agency workers charging absolutely extortionate fees. I could give the Minister in private—he would be shocked to hear them—one or two examples of what I consider to be close to blackmail.
Another question is raised: if these important services are moving, without mention in the information to my constituents, are other moves planned of which we have no information? The loss of emergency surgery, consultant-led maternity, full level 3 critical care and in-patient paediatrics was—even if most were the wrong decisions—at least clearly set out and communicated with my constituents. These acute in-patient services were not. What we therefore need, and what I have been asking for since last summer, is a clear summary of exactly what services will be available and where.
Of course, this is primarily the responsibility of the UHNM Trust. However, it is grossly unfair to place this burden entirely on it. It has been asked to do a huge job in bringing together two acute hospitals, one of which has been the subject of a major public inquiry. It needs the full support of the NHS through the NHS Trust Development Authority and NHS England. I am asking the Minister to make it his responsibility to do precisely that.
I will now turn to the tender for cancer and end-of-life services throughout the west of Staffordshire and Stoke-on-Trent. The proposal has been developed by NHS England, the four clinical commissioning groups covering North Staffordshire, Stoke-on-Trent, Stafford and surrounds, and Cannock Chase, and Macmillan Cancer Care. The objective is clear: to improve cancer outcomes, which are currently below the average for England and well below the European best, so that survival rates are among the best in England by 2025 and subsequently among the best in Europe.
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
It is a great pleasure to serve in this, your first Adjournment debate of the new Parliament, Madam Deputy Speaker. I am delighted that you have found your seat again. It is a great pleasure, too, to respond to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has been a model for many of us in the 2010 intake in his advocacy of local health issues. He was rightly recognised for so doing in the election, and I am delighted that he, like so many of my hon. Friends, was returned with such a considerable mandate as a result of his hard work. I congratulate him, too, on securing this important Adjournment debate, which continues the battle he has fought on behalf of his constituents over the last Parliament.
Let me say first that the initial meetings I have had in my new position have in large part centred on the issues raised as a result, both directly and indirectly, of the terrible events that befell the Mid Staffordshire trust. My hon. Friend’s bringing of this Adjournment debate is timely in that sense.
I shall first address some of the specific issues my hon. Friend raised about the procurements recently spoken about in the press before moving on to deal with the more general issues. None of this has been particularly helped by some of the comments in the local media. Looking at the CCG’s proposals to improve the organisation of cancer and end-of-life services, which my hon. Friend raised first, I would like to announce to him and the House today that a public-private consortium led by two NHS trusts is now the sole remaining bidder and is in the final stages of talks with the CCG to manage the cancer care pathway. This is an innovative model. I know my hon. Friend has some reservations about it, but it is the first of its kind and it should greatly help to improve and develop services for patients. It is one of the outcomes we wanted to see from the changes in his county, so that health excellence emerges out of the terrible events that occurred. I know we share a common position on that.
Four CCGs are in the process of procuring this consortium to act as a service integrator for the wide range of organisations in the area providing cancer care and to improve the journey of patients in the county and their experience of the care they receive. Dialogue will now continue.
My hon. Friend asked about the role of advisers, consultants and the associated costs. I cannot give him the details now, but I will ensure that they are provided to him. I will ensure also that all officials, including those in the CCG, have the discussion about the role of consultants and advisers in order to satisfy him—or not—on that matter.
Let me now deal with some more general points about the health economy in which my hon. Friend’s constituency sits. It is challenged, and it has been challenged for a long time. Last year, Staffordshire was identified as one of the 11 most challenged local health economies in England. The healthcare organisations in those areas need intensive support to ensure that, as a minimum, services are clinically and financially sustainable over the next five years.
Many of the problems faced by Staffordshire have lain unaddressed for years. Recruitment and retention problems are not unique to the county—other parts of the country experience them as well—but, as my hon. Friend will know, they contributed to the dreadful events on which he has become an expert. Change is needed, not just in the hospitals but in the local health economy as a whole.
As my hon. Friend has already explained, the county hospital in Stafford is now part of the new University Hospitals of North Midlands NHS Trust—in alliance with services in Stoke—but that in itself is not enough to ensure that patients get a better service. That is about much more than a change of management. A solution often used by the NHS involves concentrating services on a single site, so that professional skills are maximised and patients receive much better care.
Although there is a need to reorganise, reorganisation is not just a switch of management location; services themselves must change. That process must be led by local clinicians, working in a partnership between hospital and community, and taking the views of patients into account. The eventual structure cannot be imposed from the outside, nor can there be a “one size fits all” answer. Stafford’s geography, population distribution, transport links and distance to nearby towns and cities, for example, are all relevant to a decision on how services should be set up. Any solution must take account of those factors, as well as others such as disease prevalence and age profile, which are, perhaps, more obviously health-related.
Sir William Cash
Let me—briefly—remind my hon. Friend that people in the deep rural parts of my constituency are served by the county hospital and the University Hospitals of North Midlands NHS Trust. It is important to ensure that, when there is a lack of easy communication on the motorway, they too are specially looked after.
Ben Gummer
That is precisely the point that I made to the clinical commissioning groups when I spoke to them yesterday. I appreciate its importance, and not just on the basis of my own experience of representing an urban seat in a largely rural county.
My hon. Friend the Member for Stafford raised the issue of community beds. I need not advise him to exercise caution when it comes to believing everything that he reads in the press. However, there will be consultation about any changes that do take place, and I know that the Trust Development Authority and the commissioners will work together to ensure that they take place in a coherent fashion. Following my forthcoming meeting with chief executives and the TDA commissioners, I shall be happy to meet my hon. Friend and others to discuss changes in services if that will help to allay his concerns.
I have had detailed discussions with commissioners and NHS England about haematology and oncology services. Although there was a thought that they had been mentioned in original documents, I must say that I, too, found such mentions to be lacking. I am afraid problems of that kind are often encountered in the NHS, and that, in the past, consultations have not been as full or as pertinent as they should have been. I have asked the NHS again to consult specifically on those services, and also to engage in a full and proper consultation with patients and local groups. The same will apply to any other services that may come into question. I take my hon. Friend’s point about the need for a list of services, and I will pass it on to the CCGs, because I think it is important.
Francis Report: Update and Response
William Cash Excerpts(9 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
I thank the right hon. Gentleman for what he did when he was Health Secretary. I am well aware that in the world’s fifth-largest organisation, nothing happens just because someone issues a circular, which is why some of what we have announced goes beyond what Sir Robert precisely recommended. For example, by publishing avoidable death rates by hospital trust, we want to make the energy for change come from inside trusts, not from their being told to do things by Ministers. However, I welcome what he did as Secretary of State, and I hope we can do some other positive things.
Sir William Cash (Stone) (Con)
May I commend my right hon. Friend for his nuts-and-bolts approach and Sir Robert Francis for what is clearly an extremely good report? My right hon. Friend will know that Helene Donnelly is a constituent of mine, and that I read out a letter from her in Westminster Hall when I called for an inquiry under the Inquiries Act 2005—an inquiry that this Government set up, despite its having been refused by the previous Government and successive Secretaries of State. Will he bear in mind the need to dismiss any chief executive who does not take account of lessons learned and the fact that anyone who puts a whistleblower at risk does not deserve to hold their job?
Mr Hunt
I thank my hon. Friend because without his work and that of some of his Staffordshire colleagues we would not have had a public inquiry into Mid Staffs in the first place. Helene Donnelly has been a great inspiration to everyone who has thought hard about this subject. She had the courage and guts to stand up for patients at Mid Staffs, and she experienced terrible bullying as a result, which is why I am delighted that she is helping us. In fact, I think she is the inspiration for Sir Robert’s recommendation on “freedom to speak up” guardians. My hon. Friend is absolutely right that managers and chief executives must be completely accountable for delivering on this agenda, but we also need to send a signal to them that success for a chief executive means more than meeting A and E or 18-week targets; it is about the quality and safety of patient care.
Human Fertilisation and Embryology
William Cash Excerpts(9 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jane Ellison
I want to make a little progress, but I may take another intervention later. I am conscious that many Members wish to speak.
There has been much discussion of the safety of mitochondrial donation techniques. As I have said, three reports have been produced by the HFEA-convened expert panel during the current Parliament. On each occasion, the panel has concluded that there is nothing to indicate that the two donation techniques are unsafe. Although the panel has recommended that further experiments should be conducted, it expects such research to support the conclusions that it has reached so far.
In public discussion, there has been some misunderstanding of the term “critical”, which was used by the expert panel. That is helpfully clarified in the HFEA’s introductory briefing note, which has been endorsed by the panel and which makes it clear that the experiments could take place before or after the approval of regulations by Parliament. The chief medical officer sent a copy of the briefing note to all Members yesterday.
Sir William Cash (Stone) (Con)
Is my hon. Friend aware that there are profound legal reasons for believing that the regulations are ultra vires in respect of the primary Act—the Human Fertilisation and Embryology Act 2008—and are also in breach of the clinical trials arrangements that are set out in the European Union clinical trials directive? Does she understand that that allegation has been made, and what is her response?
Jane Ellison
The clinical trials directive applies only to medicines. It does not apply to embryology, so it is not relevant in this case.
Frank Dobson (Holborn and St Pancras) (Lab)
I have a sense of déjà vu, or perhaps déjà entendu. The objections that have been brought out today, and in previous discussions, about mitochondrial disease are identical to those that arose when Louise Brown was brought into this world at Oldham general hospital as a result of the risky work undertaken by Steptoe and Edwards and Jean Purdy. That was a risk that the scientists were willing to take and that Mr and Mrs Brown were willing to take.
Not long after I became a Member, Enoch Powell proposed a total ban on embryo research. I understand people’s ethical objections to embryo research, but if they object to something on principle, they do not need to add any other references to safety or effectiveness. If someone is opposed to it on principle, they are opposed to it, and I can respect that. When the Warnock report was published, this House had a creditable debate—to those who say that the House of Lords has a better quality of debate, I say that they should read its first debate on the Warnock report, and they might modify their views. All the things that are being said today were being said then, and all the things that were said in the debates about the establishment and development of the Human Fertilisation and Embryology Authority were the same.
In a previous speech, there were two novelties. One was that Robert Winston was being misquoted as opposing the proposal, which he cannot do any more as he actually wrote a full article in favour of it yesterday. The second was that US experts, some of the most distinguished experts who have written papers on the matter, were against it.
Jane Ellison
I will try to touch on some of the points raised in this high-quality debate, in which views have been expressed on all sides of the argument. I will deal first with the technical questions. I really cannot add to the excellent explanation that the hon. Member for Heywood and Middleton (Liz McInnes) gave of the Zhang et al study from China. She was precisely right and explained it very well.
In answer to an earlier question, we are satisfied that regulations are necessary and that they are not ultra vires. The clinical trials directive is not relevant in this context. It is part of a suite of EU measures that set out common rules across Europe to ensure the free movement of safe medicines in the EU. Mitochondrial donation is not a medicine, so those provisions do not apply. The follow-up assessment of the treatment’s efficacy is part of good clinical practice.
Jane Ellison
I am afraid that I cannot, because my role now is to respond to the points that have already been made.
On international support, Britain does not stand alone, as some Members have suggested. The Department of Health has recently received a lot of correspondence from researchers and scientists in Germany, France, the Netherlands, Sweden, Japan, Hong Kong and two states in Australia, all indicating support for UK advances on mitochondrial donation. It is also important to note that nobody is saying that scientists are of one voice or one mind on the issue, but the House should note that the overall weight of international scientific opinion is very much in favour of these techniques, and they have been looked at exhaustively.
Following the point made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I have today spoken to the right reverend Prelate the Bishop of Carlisle, who speaks for the Church of England on ethical matters in the other place, and with the Rev. Dr Brendan McCarthy, the Church’s national adviser on medical ethics, and they have told me that I can confirm that the Church is not opposed in principle to mitochondrial donation.
We have discussed germ-line therapy, with Members disputing definitions of genetic modification. The HFEA agrees that these techniques are germ-line therapy, but it has also agreed with the Government’s working definition that mitochondrial donation is not genetic modification; but I accept that others will have a different view, because there is no international or universally accepted definition.
With regard to the techniques being successfully performed in non-human primates, I can confirm that maternal spindle transfer is a technique developed in the US that has been performed successfully in non-human primates. Lord Brennan’s comments on the regulations were made to the Joint Committee on Statutory Instruments, which did not draw any special attention to his remarks. In answer to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), the regulations will not prevent mitochondrial disease caused by faults in nuclear DNA; the techniques make no alteration to nuclear DNA.
It is really important, in the seconds remaining, to point out to those Members who have said that we are rushing, and that it is open season on all these things, that that is not true. It is defined in primary legislation that the regulations can apply only to serious mitochondrial disease. There is no slippery slope. I looked back at the debates in the House on IVF all those years ago, when some were worried about a slippery slope, and all the safeguards are still in place more than two decades later. I think we can give the House confidence that we have considered this very carefully and that there is enough information. As I have said before, this is a bold step for Parliament to make, but it is a considered and informed one. We have world-leading science set in a well respected regulatory regime. For many families affected, this is indeed the light at the end of a dark tunnel. I commend the regulations to the House.
Question put.
Health and Social Care (Safety and Quality) Bill
William Cash Excerpts(9 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Jamie Reed
I am grateful to the Minister for his response and for the constructive way that we have dealt with the Bill, which in many ways demonstrates some of the best traditions of the House. I am a little disappointed, given the fallow—dare I say useless—fifth year of this five-year Parliament, that time has not been found to address these issues. The protection and use of individual data, not just in health services but across the public sector, is one of the biggest and most important emerging issues facing our politics and society, and the Minister is right to say that such matters need to be treated carefully, judiciously, and with diligence and attention to detail.
Given the cross-party support and the Minister’s assurances, I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 2
Care and Quality Commission reviews and performance assesments
‘(1) Section 46 of the Health and Social Care Act 2008 (health and adult social care services: reviews and performance assessments) is amended as follows.
(2) For subsection (3) substitute—
“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”’—(Sir William Cash.)
Brought up, and read the First time.
Madam Deputy Speaker (Mrs Eleanor Laing)
With this it will be convenient to consider:
New clause 3—Care and Quality Commission annual State of Care Report—
‘(1) Section 83 of the Health and Social Care Act 2008 (health and adult social services: reports for each financial year etc.) is amended as follows.
(2) After subsection (2) insert—
“(2AA) The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”’
Sir William Cash
Before I make my remarks on the proposals, I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my neighbour, with whom I have worked for the past five years with great enthusiasm, because he has dedicated himself to all matters in his constituency, but specifically to dealing with the problems that came out of the Mid Staffordshire public inquiry—I campaigned vigorously to get that public inquiry. I also pay tribute to Ken Lownds, whom I regard as a hero of that inquiry in many respects. I pay tribute to his work on zero harm and the Bill. I do not in any way want to leave the Minister out of the tributes because he has done a great job, as has the Secretary of State for Health. I wanted to put that on the record. We are reaching the climax of the Bill and this is the moment to pay tribute to those who so richly deserve it.
The object of new clause 2 is to amend section 46 of the Health and Social Care Act 2008. The section deals with health and adult social care services reviews and performance assessments. It comes under the rubric of reviews and investigations under chapter 3 of the Act on health care standards.
Section 46, “Periodic reviews”, provides that:
“In respect of each Primary Care Trust the Commission”—
the Care Quality Commission—
“must…conduct reviews of the provision of health care provided or commissioned by the Trust…assess the Trust’s performance following each such review, and…publish a report of its assessment.”
It also makes special provision with respect to each English national health service provider. Subsection (3) states:
“In respect of each English local authority the Commission must…conduct reviews of the provision of adult social services provided or commissioned by the authority…assess the authority’s performance following each such review, and…publish a report of its assessment.”
In the light of experience, and to improve the 2008 Act, particularly section 46, the new clause would substitute for subsection (3) the following:
“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”
The purpose of that is to require the CQC to ensure that the indicators used to assess ratings cover the safety of care, which goes back to the question of harm-free provision. Basically, the argument goes like this: the object is to stress that the CQC can be an effective regulator only if it is free of undue influence from Ministers. The measure is a good indicator of whether the Government are prepared to say that they want the CQC to be able to exert influence and carry out its functions irrespective of undue influence from Ministers. In other words, are they prepared to step back and allow the CQC to do its job properly?
The CQC has decided to make safety one of the key indicators for the assessment of provider ratings. As a result, safety is a critical component of the CQC’s new inspection regime. On many occasions, I have discussed with Ken Lownds over dinner and otherwise the origins of much of his thinking on the subject, some of which I had difficulty understanding—apparently some of it comes from aviation safety, but I will leave that to the experts.
Under the leadership of the three chief inspectors, the CQC has put in place specialist inspection teams able to scrutinise the quality and safety of care more rigorously. Inspections no longer simply consider whether providers are meeting the registration requirements, but provide a judgment about the quality of care on a scale running from outstanding to inadequate, offering providers, commissioners and local people fuller information about the quality of care.
The CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care, and the CQC has already rated many good services. That new approach has also exposed poor care and variations in care, making the level of quality transparent in a way it has never been before.
I have to say that my experience of what happened after Mid Staffordshire—this was before my hon. Friend the Member for Stafford came into the House, and I pay tribute to what he has done to help me since—was itself a matter of the gravest concern. Having witnessed what went on there, I then had to engage in a campaign, and I tried, unsuccessfully, to push the Government of the time into having a public inquiry, but Ministers, including two Secretaries of State, refused point-blank to hold one.
Furthermore, I had to nudge—if I can use that word—those on my own party’s Front Bench quite vigorously. I think that would be the appropriate description. That included our then shadow Secretary of State and the now Prime Minister, who responded magnificently, making an inquiry a manifesto commitment. One of the very first things the Government did when they came into power under the present Prime Minister was to say, “We will have this Mid Staffordshire public inquiry under the Inquiries Act 2005.” As a result of that and of the work of Ken Lownds, my hon. Friend and others of us who have been involved in this issue, including the sponsors of the Bill—I should also refer to them—we now have this new Bill in my hon. Friend’s name, which will make quality transparent in a way it never has been.
We are already confident of the great strides the CQC is making to be an effective regulator of health and social care providers. I hope that the Minister will accept that new clause 2 is exploratory, but I tabled it in the fervent belief that he will respond satisfactorily to my request, because this is a matter of grave concern.
If it is convenient, Madam Deputy Speaker, I will move on to the next new clause, unless my hon. Friend the Member for Stafford would like to respond to my points now. Would that be appropriate?
Madam Deputy Speaker (Mrs Eleanor Laing)
At this point, we are considering new clause 2 and new clause 3, so it would be appropriate for the hon. Gentleman to address new clause 3, if he so wishes.
Sir William Cash
That is very good. I just wondered whether my hon. Friend wanted to respond on new clause 2 before I move on to new clause 3.
New clause 3 proposes to amend section 83 of the 2008 Act, which deals with health and adult social services and with reports for each financial year. The new clause would insert proposed new subsection (2AA), which says:
“The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”
To put that into ordinary language, the purpose is to require the Care Quality Commission to cover safety of care in the annual state of care report. That is hugely important, because it is the narrative to which people will be able to refer in identifying progress on these incredibly important provisions.
Jeremy Lefroy
I would like to speak to new clauses 2 and 3 together. The new clauses tabled by my hon. Friend the Member for Stone (Sir William Cash) seek to embed safety as the central component of the CQC’s inspection regime. My hon. Friend is not only a supporter of the Bill but a major inspiration behind it. His determination in this place to establish what went wrong in the care of his constituents and mine, and to ensure that our NHS was improved as a result, is a major reason for us being here today.
I agree entirely with the principles contained in the new clauses. New clause 2 would place a duty on the CQC to include safety in its annual performance assessment and ratings, while new clause 3 would require the CQC to consider safety in its annual state of care report. I believe that clause 1 of my Bill would already ensure that the CQC has a duty to do all that is contained in new clauses 2 and 3. I will try to explain why.
Clause 1 states that the requirements for registration with the CQC will always cover safety by securing that registered providers of health and social care “cause no avoidable harm”. The CQC will therefore be under a duty both to consider safety in its inspections and ratings and to cover this area in its state of care report. Indeed, it already does so, and here I pay tribute to the previous Government for introducing this annual state of health and social care report through the 2008 Act.
The foreword to this year’s report, to which my hon. Friend the Member for Stone has already referred, is hard hitting about safety and indeed quality. It states:
“The variation in the quality and safety of care in England is too wide and unacceptable. The public is being failed by numerous hospitals, care homes and GP practices that are unable to meet the standards that their peers achieve and exceed.”
I welcome this candour. This is what we expect from the CQC—to hold the NHS and indeed the Government to account, and to ensure that action is taken.
Let me mention an article that appeared in The Times yesterday, showing the huge variability of standards within the NHS and praised some outstanding trusts, specifically mentioning one in Birmingham and a couple of others. What we want to see is those standards being uniform across the NHS. I know that all those working within the NHS and social care want to see that. Nobody goes into work wanting to fail; they want to succeed for their patients to whom they have a duty of care. For our part, it is our responsibility to ensure that they have the environment in which that can happen. That is a small part of what this Bill is designed to bring about.
Sir William Cash
I recall the extraordinary experience of discovering that in order for the original trust in Mid Staffordshire to achieve trust status, an interview was necessary. In that interview, I believe 48 questions were put, 35 or so of which were about finance—not about care and safety. That demonstrated why everything went wrong. Now, however, under these arrangements, the whole situation is completely reversed, which is a thoroughly good idea.
Jeremy Lefroy
I entirely agree. There were moves towards that when the Healthcare Commission, which was responsible at that stage and manifestly failed in the case of Mid Staffordshire, was replaced by the Care Quality Commission—an understanding by the previous Government that progress needed to be made in ensuring the quality and safety of care. That progress has been maintained and accelerated under the present Government.
I was referring to the 2013-14 report. One of my hon. Friend’s new clauses specifically provides that safety should be a part of such reports. Indeed, the report goes into detail over the way in which the CQC has inspected for safety. On page 12, for instance, it gives an example of a wide variation in the ratings on safety and four other measures—effective, caring, responsive and well led—for each department in a particular hospital. The ratings for safety range from inadequate to good, which shows that even within a trust or a hospital, there is a wide range of safety performance. The CQC is therefore already fulfilling what my hon. Friend is seeking in these two new clauses.
Of course, the same might be argued for clause 1 itself: why is it necessary when the CQC is now implementing the Secretary of State’s requirement to ensure that providers “cause no avoidable harm”? The reason is that, without clause 1, a Secretary of State would not have that obligation. While I cannot imagine a Secretary of State who would not consider safety and “no avoidable harm” as top priorities, experience and indeed the CQC’s own report from which I have quoted show that some of the organisations for which the CQC has the responsibility for regulation have not, and might still not, take safety seriously enough.
Sir William Cash
I distinctly remember insisting over and over again during the debates on the whole question of Mid Staffordshire that were taking place until the last general election that it was the Secretary of State who had to take the final responsibility for these matters, and that the duties imposed on him and the functions that he had to perform had ultimately to be his and must not be transferred to some other agency, however worthy it might be and however hard it might work to achieve objectives which, as we now know, were not being complied with satisfactorily, but which are being complied with satisfactorily now, under the Care Quality Commission. The argument that my hon. Friend is advancing comes straight from the history of the experience of Mid Staffordshire, and there is no one better to put the case than him.
Jeremy Lefroy
I thank my hon. Friend for what he has said. I entirely agree that this is an extremely important matter. Clause 1 will ensure that there is no slippage in the future, because the Secretary of State cannot get out of her or his responsibility, and the Care Quality Commission’s annual state of care report will be part of the process of holding the Secretary of State to account. I encourage, indeed challenge, this or any future Government to hold a proper annual debate on the report, because it is a vital report. Indeed, I should welcome a debate on the 2013-14 report, uncomfortable thought it might be for certain people.
I believe that new clauses 2 and 3 are unnecessary, because what they prescribe flows from clause 1. However, I am most grateful to my hon. Friend the Member for Stone for tabling them.
Sir William Cash
I have listened carefully to the arguments that have been put, including those from the Labour Front Bencher. In the circumstances, I am content not to press my new clauses to a vote. There will be an opportunity for reconsideration as the Bill makes further progress and it is just possible that some people will take another look at them—we will have to see. For now, I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 4
Doctors’ language skills
The Secretary of State shall by order make regulations enabling the General Medical Council to ensure that all doctors holding a licence to practise medicine in the UK have appropriate language skills to communicate effectively with their colleagues and patients.”—(Sir William Cash.)
Brought up, and read the First time.
Sir William Cash
I beg to move, That the new clause be read a Second time.
It is terribly important to use opportunities of this kind to discuss matters of such importance properly on the Floor of the House. It does not mean that we always have the right answers—sometimes, we do not even have the right questions—but there are some really important issues that need to be given an airing so that people outside can hear the nature of the discussion, rather than having that discussion held by an agency on its own account or, alternatively, by the civil service and then put forward in a Government brief.
Basically, this is a new proposal that deals with doctors’ language skills. There are many people in this country who believe that this is an important issue. It is pretty obvious that ensuring that doctors have appropriate language skills is rather important, especially given what happened in a particular case. I do not remember the names of the individuals concerned, but I seem to recall that the case involved a father who died after being treated by somebody from Germany. It seemed to be pretty likely, if not certain, that the reasons that happened were to do with a lack of proper language skills and proper experience of the medical practices in this country. The doctor was effectively coming here as a locum without appropriate qualifications or sufficient skills to be able to give the kind of treatment that was needed, and the result was a tragedy. Other Members of Parliament may have other such examples.
This is a very important issue. Indeed in April last year, the Medical Act 1983 was amended to strengthen the arrangements to ensure that all doctors have sufficient knowledge of English before being able to work in the UK. My new clause would help to ensure that all doctors were able to communicate effectively with colleagues and patients, which would sufficiently reduce the risk to patient safety caused by a lack of understanding of the English language that could result in the misdiagnosis and mistreatment of conditions. Many people regard that as common sense.
Jacob Rees-Mogg (North East Somerset) (Con)
I thank my hon. Friend for giving way. I am sorry to bring him on to familiar ground, but would this new clause be acceptable under European Union law?
Sir William Cash
My hon. Friend quite properly puts that question to me as I am Chairman of the European Scrutiny Committee of which he is a member. We always come across these questions of interpretation. The short answer is that in relation to the issue of having appropriate language skills, the parameters for the communication of information between the patient and the person giving the treatment would be described as being within the framework of public health and the importance of ensuring that the people concerned—the patient—had not only adequate treatment but the opportunity to ensure that they were not put in danger. I think that in those circumstances it would pass muster and that we could legislate on our own account. If there were ever a challenge, I would propose that we introduce a further provision reading “notwithstanding the European Communities Act 1972” and then legislate. If we did that, under sections 2 and 3 of the 1972 Act the notwithstanding formula would enable us to bypass the European Court of Justice and ensure that we could legislate on our own account in this House to ensure that language skills were needed in English to ensure that patients in this country were properly safeguarded. I hope that I have dealt with my hon. Friend’s point.
Sir William Cash
I see him nodding and I am glad that I managed to pass that test. I am always grateful to my hon. Friend, who ensures that we all keep up to the mark.
On this occasion, I think we would have the capacity to make the change in the first place, but, if not, perhaps we can take a belt-and-braces approach in the House of Lords and use the notwithstanding formula. We shall see.
Jeremy Lefroy
Again, I am most grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling this new clause, which covers an important subject—the language skills of doctors—although of course the language skills of all involved in clinical care are vital.
Clear and understandable communication is essential to safety and the quality of care of patients. Language skills are a necessary condition for good communication, but not a sufficient condition. They must be accompanied by good communication skills, with which not all of us are automatically blessed, however good our language skills. Communication skills teaching is now an essential part of training in medical and nursing schools and it is to the credit of the previous Government that they ensured that it was embedded in the curriculum of new medical schools and was taken forward in existing schools. I welcome the Government’s support for that important approach.
I understand that regulations have been in place for a short while to ensure that all doctors, whether from within or from outside the European Union, have appropriate language skills before being granted a licence to practise. I want to hear from the Minister what the effect of those important regulations has been and whether he believes that new clause 4 is necessary. I would also like him to consider whether the assessment of language skills should include communication skills within that language.
Jacob Rees-Mogg
I want to speak in support of my hon. Friend the Member for Stone (Sir William Cash). This is an important new clause on a matter that it would be wise to have clearly set forth in primary legislation.
The heart of the matter is, unfortunately, the European Union and the mutual recognition of qualifications within the EU, and there are good reasons for that. The only way to open up service industries generally is if mutual recognition of qualifications takes place, so if we are to have a single market in services that is an important basis for it. However, above and beyond that there must be a fundamental principle of patient safety, which is embodied in this excellent Bill, and a lack of good language skills and of understanding of a language is a danger in both directions. It is a danger for the doctor who is listening to the patient explain his or her symptoms and it is also a danger when the doctor explains to the patient what steps the patient needs to take for better health. If there is confusion, it can have a seriously deleterious effect on the patient’s health.
We must be clear that this is not about restrictive practice or protecting the market for British doctors but about ensuring that there can never be such confusion. As my hon. Friend the Member for Stone says, if this provision runs into trouble with the European Union, we need to state clearly that it is of such fundamental importance that it must override international treaty obligations. It was Disraeli who said in his speech in the Manchester free trade hall in 1872, “Sanitas sanitatum, omnia sanitas”—that the first duty of Minister is the health of his people. That statement has underlined and guided Conservative policy for nearly a century and a half.
Sir William Cash
I recall that Disraeli also said, “The Tory party is a national party or it is nothing.”
Jacob Rees-Mogg
Indeed, although I am less clear on the relevance of that, and I was not intending to swap Disraeli quotations all morning. I just wanted to make that point about a fundamental principle that has guided our party since the 1870s and its relevance in defending health through ensuring that there is a proper standard of English-speaking—or in Wales, Welsh-speaking—physicians.
Sir William Cash
My hon. Friend used the word “ensuring”. That reminds me that insurance is a very important ingredient in the question of health and language skills—and, as my hon. Friend the Member for Stafford (Jeremy Lefroy) said, communication skills as well. If there were to be a failure of language, the consequence of which was to breach the terms on which an insurance contract was devised as between the patient and the national health service, as well as others involved in the contractual relationship, there would be massive financial consequences that could, in certain cases, run into millions of pounds.
Jacob Rees-Mogg
My hon. Friend makes an interesting point. It is possible that that is taken care of by other parts of the Bill. Clause 1 contains the fundamental commitment that unreasonable risks should not be taken, and language could be seen to be part of that. The reason I like the new clause is that it makes it absolutely clear that language is fundamental.
It is very hard to think of a circumstance where a lack of communication could possibly be safe. There may be cases where a patient cannot speak, or absolutely dire emergencies where there is no alternative form of treatment, but in the ordinary course of events language skills must be essential for somebody who looks to work in this country for any length of time.
I hope that the Government will think about this new clause very seriously, and perhaps consider whether a “notwithstanding” aspect is necessary, and that if they do not accept it today, they will look at the matter again in another place.
Philip Davies
My hon. Friend makes a good point. That enhances the complication that could arise as an unintended consequence. I agree wholeheartedly with the sentiment of the new clause and the intention behind it, but I wonder whether its wording may lead to unintended consequences in relation to languages other than English that were not foreseen when it was tabled.
Sir William Cash
As my hon. Friend will appreciate, the new clause says:
“The Secretary of State shall by order make regulations enabling the General Medical Council to ensure that all doctors…have appropriate language skills to communicate effectively”.
I am not prejudging this—I will be interested to hear what the Minister says, if he can take advice on the matter, and of course there is the House of Lords to come—but it may well be that the regulations can identify how my hon. Friend’s points, which I completely understand, can be addressed.
Philip Davies
I am grateful to my hon. Friend. He may be right that the points I make can be overcome in one way or another, whether through his existing wording, which may well work, or perhaps a slightly amended version in another place. I just wanted to flag up this issue because I would not want any unintended consequences to come about as a result of the new clause. The whole point is that the onus should be on everybody to be able to speak English, and I would not want anything to allow for a loophole that prevented that from happening.
I wholeheartedly support the sentiment underlying the new clause. Integration is essential in this country and speaking the language is one of the key forms of integration. I do not see how it is possible to integrate into society if one is not competent in speaking English. I support the idea that people who come to this country should be able to speak English, whether they are patients or doctors—the requirement should apply to both equally. I shall be interested to hear the Minister’s view.
Dr Poulter
I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.
I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.
To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.
Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.
The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.
One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.
In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.
However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.
The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.
Sir William Cash
Is the Minister satisfied that the measure complies with European law and that we do not need a notwithstanding arrangement? He may hope that it will not fall foul of the European Court of Justice, but has he taken advice on that? If not, will he do so after we have finished our proceedings?
Dr Poulter
I hope I can reassure my hon. Friend on that. I am absolutely sure that our measures are consistent with European law and I took advice consistently on that, although there was a difference of opinion in how the previous Government and this Government interpreted advice. I work very closely with the General Medical Council, which receives its own independent advice, and I worked with its former chair, Sir Peter Rubin, who has been a tireless campaigner for the measure. Together with the GMC, we introduced measures that are consistent with European law and mean that we are able to test the language competency of EU doctors. I am sure that there is consistency: a similar process is in place in Bavaria in Germany. Although there can be free movement of qualified health care professionals to different member states—their skills can benefit our NHS—it is also important that they can perform a doctor’s functions properly, and it is not possible for them to do that if they cannot speak English and communicate effectively with patients. Our measures are consistent with the advice I have received and, indeed, with the views of the GMC. This is the right thing to do and I am pleased that the coalition Government have put in place language tests.
Last April, I led through this House changes to the Medical Act 1983 to strengthen the arrangements to ensure that all doctors, including those from within the European economic area, must have sufficient knowledge of English before being able to work and look after patients in the UK.
I hope my hon. Friend will agree that patients are much better protected by the new powers the Government have given to the GMC. When the GMC implemented language checks for European doctors in June 2014, it also raised the pass mark for its language tests. The GMC has vigorously used the powers given to it by the Government. Since the Government changed the legislation last April to strengthen the language test arrangements, 128 EEA doctors have been refused a licence to practise medicine in the UK owing to inadequate language skills. That shows that the measure is working to protect patients in the UK from EU doctors who cannot speak English effectively. It is having an effect—it is biting—and making sure that patients are being properly protected. I will write to hon. Members to outline the measure further, and I will perhaps ask the GMC to contribute to that letter. The measure was long overdue and I am proud that we introduced it. It is protecting patients in the UK from doctors who cannot communicate effectively.
As part of a belt-and-braces approach to ensure that all doctors looking after patients can speak a good standard of English and communicate effectively with them, in 2013 responsible officers in England—senior doctors in health care organisations who oversee the employment of other doctors—were given additional statutory responsibility for ensuring that doctors
“have sufficient knowledge of English language necessary for the work to be performed in a safe and competent manner”.
In addition, on medical revalidation, which was raised by my hon. Friend the Member for Shipley, the Government have taken the important step of ensuring that all doctors must show evidence of competency on a maximum of a five-yearly basis in order to maintain their medical licence. That has improved checks on all aspects of a doctor’s work, including how well they work as part of a multidisciplinary team, how well they communicate with their patients and whether they are keeping up to date with medical practice.
Dr Poulter
The revalidation process is ongoing and is reviewing everybody on the medical register. It is very easy to revalidate someone who is training to be a specialist as a surgeon or in some other hospital position, because they are assessed annually as part of their specialist training. The revalidation process for the consultant and general practice work force—which kicked off as a five-year programme—is ongoing. Some people have volunteered to come off the medical register, including retired doctors who have not practised for some time. I would be happy to write to my hon. Friend to update him on the revalidation process. It will not be completed for another couple of years, but once we have gone through the first cycle of revalidation the process will be easily repeated. I stress that doctors will be revalidated on a maximum of a five-yearly basis. It is possible for the GMC to seek reassurance with regard to certain specialties by requesting more regular competency tests as part of the annual appraisals.
The revalidation process is an important new power that is being implemented effectively. We need to keep it under review because it is important that all doctors, regardless of the proposed new clause on language testing, are competent, keep up to date with medical practice, able to communicate effectively and empathetically with their patients, and work as part of a multidisciplinary team for the benefit of patients. That applies to general practitioners, hospital specialists and those working in mental and physical health. It is an important step for which the GMC has been asking for many years and in which other health care professions are taking an interest. The Nursing and Midwifery Council is considering revalidating nurses in a similar way in future. It is a welcome measure that will help protect patients and the public. It is making good progress and I will write to my hon. Friend with further details in due course.
Medical revalidation is the process by which the GMC evaluates whether doctors can keep their licence to practise in the UK. In addition, a doctor wanting to work in general practice in the UK must also be on the national medical performers list, which is managed by NHS England. To be included on the list, the doctor must hold a licence to practise from the GMC and, as a consequence of the revalidation programme, he or she must have effective communication skills.
As I outlined earlier, the key step to improving checks on language competency for EEA doctors was the Medical Act 1983 (Amendment) (Knowledge of English) Order 2014, which made changes to the Medical Act 1983. My hon. Friend the Member for Shipley will be pleased to hear that the title of the order refers to English. After all, the General Medical Council regulates doctors on their ability to speak primarily that language, and I hope that that reassures him.
The order gave the General Medical Council the power to refuse a licence to practise to a medical practitioner from within the EU who is unable to demonstrate the necessary knowledge of English. It created a new fitness to practise category of impairment relating to language competence to strengthen the General Medical Council’s ability to take fitness to practise action where concerns are identified.
For example, if I, as a doctor, worked with a doctor about whose language competency I had concerns, or if a doctor was not able to communicate effectively in their day-to-day work, I, fellow health care workers and patients could report the doctor to the GMC, which—in addition to the existing initial point-of-entry language testing powers and the revalidation process—now has new powers to take action specifically in relation to such language concerns. That is another important measure that the Government have introduced to strengthen the GMC’s powers on language testing.
The change enables the GMC to require evidence of English language capability as part of the licensing process in cases where language concerns are identified during registration. Just as doctors from outside the European economic area can be tested on their language competency, the same competency tests now apply to doctors coming to work in the UK from within the European economic area, thanks to the new regulations. We hope that the wrongs identified following the dreadful Daniel Ubani case and the tragic death of David Gray have now been righted through very strong legislation to ensure the competency and ability to communicate in English of all doctors coming to work in the United Kingdom. As I have outlined, additional measures are now in place to enable the GMC to take action if concerns are raised during the ongoing medical practice of any doctor about their ability to speak English and to communicate effectively with their patients.
The process for determining whether a person has the necessary knowledge of English is set out in the General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012. The GMC has published guidance setting out the evidence required to demonstrate that a person has the necessary knowledge of English. With regard to the fitness to practise changes that have been introduced, a new category of impairment relating to English language capability has been created, which allows the General Medical Council to request that a doctor about whom concerns have been raised undertakes an assessment of their knowledge of English during a fitness to practise investigation.
The changes have hugely strengthened the General Medical Council’s ability to take fitness to practise action where concerns about language competence are identified in relation to doctors already practising in the UK. We are in the process of bringing in similar powers for the Nursing and Midwifery Council, the Pharmaceutical Society of Northern Ireland, the General Pharmaceutical Council and the General Dental Council to ensure that the health care professionals they regulate—nurses, midwives, pharmacists, pharmacy technicians, dentists and dental care professionals—will also have appropriate language skills for the roles that they perform. The consultation on our proposed legislative changes for those four regulators closed on 15 December, and we will publish the outcome shortly with a view to immediate legislation.
I want to pick up the good point made by my hon. Friend the Member for North East Somerset about the need for primary legislation. I hope that he is reassured that the existing legislation, and the ability to bring in regulations underpinning that through section 60 orders underpinning the Medical Act 1983 and other Acts, provides the ability to bring in strong regulations to protect patients and the public in respect of language competency. The Government have done exactly that. There will be future opportunities to legislate in the form of a Law Commission Bill, which would make it possible to neaten up the already very robust and strong regulation on language testing that we have introduced. I am sure that we will consider doing so at the first opportunity.
I hope that such measures will reassure my hon. Friend the Member for Stone. Thanks to this Government, strong laws have been passed, and very strict new rules are now in place to ensure that doctors practising medicine in the UK can do so only if they can communicate with patients using a high standard of written and spoken English. With that reassurance, I hope that he will withdraw his new clause.
Sir William Cash
I have listened to the Minister with great care and interest on the question of language skills. Despite his comprehensive description of the measures brought in, I feel that one or two areas might yet be usefully considered in the other place. I would be extremely glad if somebody raised them, just to test those measures further. This is the first time that we have heard such an excellent and comprehensive analysis on the Floor of the House in relation to a Bill of such importance. We are talking about situations in which there should be zero harm, so we do not want any doubts on the question of English language skills. In practice, I am prepared to withdraw the new clause, with the proviso that the matter should be looked at again in the other place at a future date. I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
Third Reading
Sir William Cash
I simply want to say how glad I am that the Bill has reached its Third Reading and to congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on piloting it through, with the conspicuous help of the Minister and the Government. As I have said before, Ken Lownds and others have also been involved. Over the many years that I have been involved in the Mid Staffordshire situation, Ken Lownds has been a tower of strength, and we are all very grateful to him.
This is a Bill of national importance on a scale way beyond that of many private Members’ Bills. My hon. Friend deserves congratulations from all parts of the House on bringing it forward. I am glad that the Opposition are giving it a fair wind because it has a truly national purpose. It is in the interests of everybody that we achieve the kind of zero-harm care to which we should aspire.
I am extremely glad that the Bill will now go to another place, where, as my hon. Friend said, there are many experts who will no doubt say quite a lot about it. There may well be further amendments that will come back to this place. I urge their lordships to have regard to the importance of the Bill and the principles that lie behind it, and to seek amendments in the light of the fact that it is about our constituents. We, as an elected House, know—certainly my hon. Friend and I know—of the hard experience and tragedy that have been experienced by our constituents. Our constituents—the people of this country—deserve to have the improved health care that the Bill will help to achieve.
After those few words, I simply reiterate my thanks to my hon. Friend.
Mitochondrial Replacement (Public Safety)
William Cash Excerpts(9 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Fiona Bruce
Thank you, Mr Deputy Speaker.
Parliament should be allowed to deliberate on and debate this issue at length, but that might not happen. I understand that the Government propose to lay regulations permitting PNT and MST before the end of this year. Sir John Tooke, president of the Academy of Medical Sciences has said:
“Introducing regulations now will ensure that there is no avoidable delay in these treatments reaching affected families once there is sufficient evidence of safety and efficacy.”
In other words, Parliament should vote blind and sign off legislation permitting these procedures before the recommended experiments—some of them critical, regarding safety—have been completed.
Sir William Cash (Stone) (Con)
As a veteran of these debates, going right back to 1985, I wish to commend my hon. Friend enormously for what she is saying and doing. There has been a history of manipulation, involving packing of committees, for example, over an extremely long period. My hon. Friend is right to take the line she is taking: it is not just about health and safety, but about the whole question of the ethical and moral values that lie behind attempts to manipulate genes. We all want to help people; the question is whether this is the right way to do it. I emphatically believe that it is not.
Fiona Bruce
I thank my hon. Friend for that intervention.
Even more worrying than the quotes I have cited from the HFEA is the fact that many scientists, national and international, have gone further in publicly stating that these procedures should not be authorised at all—and not necessarily because they are against them in principle, as some are not against them. Stuart A. Newman, professor of cell biology and anatomy at New York medical college has described these proposals as “inherently unsafe”. Paul Knoepfler, an associate professor in the department of cell biology at the UC Davis school of medicine recently wrote that a process of this kind
“could trigger all kinds of devastating problems that…might not manifest until you try to make a human being out of it. Then it’s too late.”
Francis Report
William Cash Excerpts(10 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
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.
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.
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.
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.
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.
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.
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.
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.
Mid Staffordshire NHS Foundation Trust
William Cash Excerpts(10 years, 3 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jeremy Lefroy
I am most grateful to my hon. Friend. I will come to that important point.
I pay tribute to the work of Support Stafford Hospital, because the impact of its campaign has shown just how much the community values the services at Stafford and Cannock. I also pay tribute to the working group, which I set up, and all those who have worked with me on that to provide us with the detail on alternative proposals, some of which I shall outline.
There is no doubt that the administrators listened carefully to what was said in the consultation and made a number of changes in their final proposals. However, the proposals as they stand are insufficient. What I am setting out requires not a re-doing of all the work of the trust special administrator—given what I have said about the urgency of the situation, that would not be sensible—but a modification of the detail.
I do not believe that such a modification would necessarily require more money than is currently proposed, although that remains to be seen, but it would be of huge benefit to many thousands of my constituents, and those of hon. Friends and other hon. Members. It will also ensure that both Monitor and the Secretary of State can fully comply with their legal obligations under the Health and Social Care Act 2012, in respect of health inequalities, as I will show later.
My proposal is that rather than cutting three areas of service in Stafford, those continue in a more cost-effective form, at least for two or three years. I, and the clinicians at Mid Staffs, consider that it will be quite possible to show how these services can be run across the two sites in Stoke and Stafford on a networked basis. The areas concerned are paediatrics, obstetrics and maternity and critical care.
First, the report proposes a reduction of the critical care unit to four beds. It says that the possibility of the highest level of critical care—level 3—should be maintained, but it is not clear how this will be possible without a rota for specialists in critical care. The critical care department at Stafford made its own submission to the consultation, which suggested a reduction in beds and a networked specialist rota. That seemed eminently sensible. Given that the CCU at Stafford is a net contributor and supports several other activities, I urge Monitor and the Secretary of State to determine that this model is tried for a period, during which it will, hopefully, be proven to operate well, clinically, operationally and financially.
The TSA’s final report also proposes, as my hon. Friend the Member for South Staffordshire (Gavin Williamson) mentioned, removing the consultant-led obstetrics and maternity service and replacing it with a midwife-led unit dealing with approximately 350 to 400 births a year. That is a step forward from the draft report, which proposed no childbirth at all at Stafford. However, my constituents and I do not believe that it is sufficient.
Currently, Stafford sees more than 2,000 births a year and that is likely to rise, with extensive house building, various new business parks being built and the doubling of the size of MOD Stafford, to mention but some developments, resulting, in the coming years—even with a MLU—probably in some 2,000-plus babies being born in other maternity units, mainly at Stoke and Wolverhampton. UHNS in Stoke already sees some 6,000 a year and its population is also growing. With at least 1,000 births, and probably more from Stafford, UHNS will probably approach 8,000, which is the number currently born at the largest unit in the country, in Liverpool.
The NHS rightly promotes choice for women about where to have their babies and the Prime Minister has spoken out against the trend towards ever larger units. Yet that is precisely what is being proposed here for women who are unable to use a MLU, due to the possibility of complications in childbirth. There would also be an impact on those who currently use UHNS and the Royal Wolverhampton, as their local units will become even busier—probably including Walsall as well—taking in women from a much wider area.
My proposal, and that of clinicians at Stafford, is to continue with the current service, fully networked with UHNS, while the impact of the current rise in both the population and birth rate is assessed. That would also enable the special care baby unit at Stafford to continue to support the regional intensive care network for babies, as it currently does. An added benefit would be that women will continue to have a local obstetric and gynaecology service, which I am sure the Minister will appreciate as he comes from that specialty. Again, that would relieve pressure on the larger University hospital of North Staffordshire and the Royal Wolverhampton hospital.
Thirdly, the TSAs propose to reduce the paediatric assessment unit to 14 hours a day from 24 hours a day and to do away with in-patient paediatric beds. There will be no paediatric rota, although A and E doctors will receive extra paediatric training and paediatric out-patient services will continue. The principal reason given by the TSAs is the national standards of the Royal College of Paediatrics and Child Health, which state that such services should be provided by a full consultant rota, which is usually between eight and 10 consultants, whereas at Stafford it is between five and six.
Let me be clear about the consequences: if the proposal is allowed to happen, the clear logic is that dozens of other paediatric units across the country that have similar numbers of consultants, or indeed fewer consultants, must be closed or have their activities drastically curtailed. Monitor cannot use the argument that that must happen at Stafford but not at other foundation or NHS trusts for which Monitor or the NHS Trust Development Authority are responsible, and neither can the Government.
The argument that all in-patient paediatric care should take place in the largest hospitals is not accepted by the general public. They fully understand why very sick children should go to specialist units; they do not understand why their local general hospital cannot receive sick children at night or for short stays, and neither do I. If experts at the Royal College insist on making that argument, however, let it be open, let it be consistent across the land and let it be agreed by all political parties. The proposal should not be implemented by stealth through a trust special administration that in no way arose because of the performance of the paediatrics department at Stafford.
I have one final point.
Mr William Cash (Stone) (Con)
I have been waiting for my hon. Friend to reach his conclusion so that I can say how much I support him in his endeavours on Stafford hospital, which affects my constituency of Stone. I had to fight so hard to get the public inquiry that has led to many of the changes, and I simply offer him many congratulations. I support pretty much everything that he says, and I believe that he has done an enormous service to his constituents through his work over the past few years.
Jeremy Lefroy
I am most grateful to my hon. Friend, and I return his compliments. He has likewise tremendously supported the trust and the work that has been done.
My final point is that the children and families who will be most affected by the paediatrics proposal are those on the lowest incomes. Such families are the least likely to have access to private transport to take their children nearly 20 miles to the nearest hospital at night. For them public transport in the daytime is often poor, and a taxi fare is beyond their means—certainly if they have to visit a sick child several times. I believe that those on low incomes should have fair access to health care, which both Monitor and the Secretary of State have a responsibility to ensure.
The paediatrics department at Stafford made an alternative proposal in its response to the consultation. That alternative was measured and understood the need to cut costs. The alternative proposal included a reduction in the number of in-patient paediatric beds, and consultants would have worked in a network across both of the new trust’s sites.
A pattern can be seen: critical care, maternity and paediatrics. There are sensible alternative proposals.
Dr Poulter
I will of course respond to those that I can, but as the hon. Lady will be aware and as I will set out later, the TSAs’ report is currently with Monitor—I would expect it to be recommended to the Secretary of State by the end of this month—so it would be inappropriate for me to comment on it at this stage. I hope she understands that it would be wrong for me to make assumptions about a report that has not yet been submitted to the Secretary of State.
Dr Poulter
My hon. Friend makes an important point. The Secretary of State has previously given that assurance, and I give my hon. Friend that assurance again today. It is obviously for the Leader of the House to organise Government time, but I will have conversations with and write to him following this debate to ask him to expedite the issue.
Returning to the report, the TSAs have also highlighted the serious clinical implications of failing to act. They predict that services operating below the recommended consultant level, such as A and E, would need to be reduced. Low-volume services would risk being closed altogether, forcing patients to travel further for treatment. Throughout the process, the TSAs have stressed the fragility of the trust and emphasised the huge importance of agreeing to and implementing the changes required as soon as possible.
I will now move on to the next steps, about which all hon. Members are concerned. I know that it is frustrating for hon. Members wanting answers that I cannot provide them all today. The report is currently with Monitor, so it is for Monitor to make recommendations to the Secretary of State on the basis of that report. That will be the appropriate time for the Secretary of State and Ministers to comment. That may be frustrating for hon. Members, but that is the way that things need to be. We cannot comment on the matter until Monitor has made its recommendations. If Monitor is satisfied with the TSAs’ final proposals, the Secretary of State will have a maximum of 30 working days to consider them against a set of requirements defined in legislation. These aim to secure services for patients that are of a sufficient level of safety and quality and that offer good value for money. The Secretary of State will consider each requirement carefully before coming to his final decision.
As I have said, it would be inappropriate for me to pass further comment today on the TSAs’ final report because its final version has not yet been submitted. It is clear from the debate, however, that there is widespread interest from around the region and from local Members who are concerned about the wider impacts of the report on the health care economy and on services for other local patients. I am confident, however, given the interest from Members and the support provided to the trust from other health care trusts and hospitals in the area, that we will come to the right conclusion. We all want to see a strong and viable health care service for patients in Stafford and the surrounding areas, and I am confident that that is what we will have delivered once the Secretary of State has considered the report.