Mid Staffordshire NHS Foundation Trust

William Cash Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

I congratulate the right hon. Lady on the extremely good report that she produced. I hope she will not find herself in a position of wanting to complain to me about the way in which I have implemented her report on complaints, because we intend to take it extremely seriously. She knows that I basically accept everything she said in it, although we will have to work carefully on the implementation of some things to make sure we get them right. She highlights one of the most fundamental problems. Probably the biggest problem is that some hospitals treat their complaints procedure as a process rather than something that they can learn from. Every NHS patient whom I have met who has had problems only ever says the same thing. They just want to know that the NHS will learn from what has gone wrong. That is all that they are interested in.

The point that the right hon. Lady makes is a very important one. People do sometimes feel that it is them against the system, and taking on a big establishment that might be well funded and is not really interested in hearing what they have to say is a very lonely process. It is vital that everyone who wants it can get independent support. One thing that we will be requiring is a sign, prominently displayed in every ward of every hospital, telling people, first, how they can make a complaint, and secondly, how if they want it they can get independent help and support. That could be a very good role for the new healthwatch organisations, but it may not be them in all cases, so most importantly, we will insist that people everywhere can access that independent help.

[Mr William Cash (Stone) (Con)]

Did my right hon. Friend hear my constituent, Debra Hazeldine, this morning on the “Today” programme, with a harrowing description of the way in which her mother was let down and died in Stafford hospital? I agreed with everything she said. Does he acknowledge that, although my right hon. Friend the Prime Minister listened, after correspondence and meetings with him, to my repeated calls and motions for the setting up of an inquiry under the Inquiries Act 2005, which the Prime Minister set up and which has led to a complete shake-up, not only of Mid Staffs but the entire health service, successive Labour Secretaries of State in the last Government disgracefully and repeatedly refused to agree to such an inquiry, and that but for our determined campaign with Cure the NHS, and in particular Julie Bailey, Debra Hazeldine and Ken Lownds and his campaign for zero harm, the 2005 Act inquiry would never have taken place and the Francis report would never have been produced, with all its beneficial consequences, in the Secretary of State’s hands, for the NHS in the national interest? When will the debate take place on this report on the Floor of the House in Government time?

Hospital Mortality Rates

William Cash Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

As I said in my statement, in nine of these 14 trusts, the chief executive or chair has been either replaced or moved on. However, the most important thing that we are doing is setting up a transparent failure regime, so that when problems arise they will be made public, so the system will never know something that the public do not, and so that Ministers will be required to take action to sort out failing hospitals. That is what is happening under this Government, but I am afraid that it did not happen when the right hon. Lady’s party was in power.

[Mr William Cash (Stone) (Con)]

The Keogh report, which must be welcomed, followed the Francis report. Despite my continuous attempts to have a full public inquiry under the Inquiries Act 2005, successive Labour Secretaries of State refused. Can my right hon. Friend find out from the Department or in any other way how that happened? Will he be good enough to publish his findings, because the root of the real trouble is that they were not prepared to have an inquiry and it was a cover-up?

[Mr Hunt]

My hon. Friend knows that the Labour party refused 81 requests for a public inquiry into what happened at Mid Staffs—I repeat: 81 requests. He also knows that if it was not for that public inquiry, we would not be here now. That is the biggest lesson to learn about the benefits of a public inquiry, and that is why transparency matters. I hope he is also pleased that we will be having a debate on the Francis report in Government time later this year.

Stafford Hospital

William Cash Excerpts

Thursday 4th July 2013 Commons Chamber

[Mr William Cash (Stone) (Con)]

I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy) for his tireless work in relation to Stafford hospital. I myself campaigned vigorously and successfully for a public inquiry, and was able to give evidence to it. However, the Government have still not arranged a debate on the Francis report, although it was published many months ago, in February. That is completely unacceptable. I know that the Secretary of State for Health wants a debate, so, for heavens sake, will the Government get on with it? Will they have their discussions, so that we can debate the matter and establish the root causes of what went wrong?

If the discussions do not produce the results which, as my hon. Friend said, are absolutely necessary, the national health service itself will not be able to live up to what people have claimed that it can produce. It could stand or fall on the basis of the results of those discussions. As we know from the media, many people are questioning the workings of the national health service, and with some justification. If the Government get this right, the health service as a whole will benefit enormously. I urge them to act.

Let me also say that the Prime Minister himself has expressed his concern about the treatment given to Julie Bailey, and we are following that up with the police.

Finally, I ask the Government and the Minister to make certain that Stafford hospital is given an opportunity not only to prove itself, but to prove that the national health service can work properly.

Mid Staffordshire NHS Foundation Trust

William Cash Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

I am not avoiding it. I agree that adequate staffing levels are essential to patient care. I remind the hon. Lady that the shadow Health Secretary said to the Francis inquiry:

“I do not think that the Government could ever mandate a headcount in organisations. Whilst we could recommend staff levels, we were moving into an era when trusts were being encouraged to work differently and cleverly, and take responsibility for delivering safe care whilst meeting targets”.

[Mr William Cash (Stone) (Con)]

The Secretary of State rightly talks about a betrayal of trust of the worst kind, and he is right. He is also right about zero harm, and about much else that he has done. But there is one serious omission—of accountability—and that must be robust and include the resignation of Sir David Nicholson. I also apportion responsibility to those former Secretaries of State who were not called to give evidence but bear a heavy responsibility for not having done the right thing at the right time.

[Mr Hunt]

My hon. Friend knows that I have a different view of the level of responsibility of Sir David Nicholson, but I agree that everyone working in the system at that time shares some responsibility for what happened. We must make sure that it can never happen again. The accountability that we are introducing, including criminal sanctions for boards that fail in their statutory duties, will be a significant change. The body that was responsible for what went wrong at Mid Staffs, according to Francis, was the board of the hospital, so that is where our focus must be. Today is also about getting the right structures outside the hospital to make sure there is accountability there too.

Accountability and Transparency in the NHS

William Cash Excerpts

Thursday 14th March 2013 Commons Chamber

[Andy Burnham]

No, I will not. I was copied into an e-mail by Professor Brian Jarman in mid-March 2010 and, having asked the CQC to investigate what he had said, I wrote back to him on 31 March 2010. That was literally my last duty as Secretary of State for Health after the general election was called. I was not able to respond further to inquiries. It is important to provide some balance to the hon. Gentleman’s comments.

Changing the culture in the NHS requires vigilance and persistence. As Robert Francis says, we have all been too remote from the front line.

The foundation trust reform was a serious attempt to end the top-down culture in the NHS, bringing more accountability and transparency. If we look back, however, we will see that, when the centre stood back, there were places where an unhealthy local culture became even more firmly established. In some trusts a national top-down style was replaced with a local top-down, bullying style, which can be even worse. I can remember the shock I felt on reading the first Francis report’s finding that, on receiving FT status, one of the first things that the Mid Staffs board did was to resolve to hold more meetings in private. That was an audacious breach of the spirit of the legislation passed by this House.

[Mr William Cash (Stone) (Con)]

The shadow Secretary of State and I have been engaged on this issue for a very long time. Will he admit that it was totally unacceptable for him and his predecessor to refuse to have a public inquiry, which I demanded relentlessly, under the Inquiries Act 2005? Does he agree that it was wrong to give foundation trust status when it clearly should not have been given, and does he accept that I raised the issue of gagging orders and confidentiality in a health debate in 2009, not 2010?

[Andy Burnham]

Foundation trust status was not a matter for Ministers. It was a job for Monitor, so it has to answer that concern. The hon. Gentleman is right that we had many discussions about a public inquiry. He will remember that in July 2009, two months after I was appointed Secretary of State, I brought in Robert Francis QC to conduct an independent inquiry into what happened. I did not order a full public inquiry and I will explain the reason why later.

The difficult thing about the fact that the Mid Staffs board was holding more meetings in private was that we in this House had passed up our powers to intervene to stop it. That is another lesson we must learn: that the FT reform was naive in thinking that local autonomy would lead to improvement in all cases. In a national health service, there are areas where national direction is needed, and when things go wrong, there must be immediate powers of intervention, which, on my arrival in the Department in June 2009, I found I did not have. Foundation trust policy needs to be reviewed and adjusted to mitigate those dangers, including through a reconsideration of the power to de-authorise a failing foundation trust, which was recommended by the first Francis report, but repealed by the Health and Social Care Act 2012.

We also need to consider targets and how they are used. Targets helped to deliver the lowest waiting times in history and that must not be forgotten. However, in places, they reinforced negative management practices. In focusing on only part of the patient experience, there was not sufficient focus on the overall patient experience and the whole person—a particular problem when it comes to caring for very elderly people whose needs are a blur of the physical, mental and social.

Robert Francis is right to call for a fundamental rethink of the way in which we care for older people, and I have put his recommendations at the heart of Labour’s policy review. However, there are more immediate things that we can do and I will spend the rest of my time on five substantive points.

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[The Secretary of State for Health (Mr Jeremy Hunt)]

I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this important and timely debate.

We should start by remembering why we are having this debate. Truly shameful things happened at Stafford hospital. Patients were left unwashed for days, sometimes in sheets soiled with urine and excrement. Relatives had to take bed sheets home to wash them because the hospital would not. Patients with dementia went hungry with their meals sitting right in front of them, because no one realised or cared that they were unable to feed themselves. If we are to prevent that from happening again, accountability for what happened is vital. I will talk plainly about that, including about the role of Sir David Nicholson.

At the outset, let me reiterate that the NHS is one of our most cherished institutions. We can be proud that for 65 years it has ensured that everyone is entitled to treatment, regardless of their background or income. We can be proud of the excellent treatment and care that is the hallmark of most parts of the NHS. Most of all, we can be proud of the front-line doctors, nurses and health care assistants who look after 3 million people every week, with dedication, commitment and compassion.

If we love the NHS, we must be prepared to be honest about its failures, and to criticise me for doing so suggests, I am afraid, dangerous complacency from the right hon. Member for Leigh (Andy Burnham). The tragedy of Mid Staffs shows how the desire to celebrate success got in the way of speaking out when things went wrong, and if we are to prevent such things from recurring, we must never allow our love of the NHS to stifle our determination to hold systems and individuals to account.

Where does that accountability lie? Sir David Nicholson has been the focus of much attention, and as a manager in the system that failed to spot and rectify the appalling cases at Mid Staffs, he bears some responsibility. As he said, the focus was lost, and he has apologised and been held to account by this House and many others. However, I do not believe that he bears total, or indeed personal, responsibility for what happened. He was at the strategic health authority for 10 months during the period in question, overseeing 50 hospitals at a time when his main responsibility was the merger of three SHAs into one. He consistently warned both Ministers and managers of the dangers of hitting the target and missing the point.

It is just not true that if there had been no David Nicholson at the SHA, there would have been no Mid Staffs; others bear far more direct responsibility and the Francis report tells us who. It makes it clear that the primary responsibility for what went wrong lies with the board of the trust. Astonishingly, members of that board seem to have melted into thin air, some moving to other jobs in the system, and others receiving generous payoffs.

[Mr Cash]

As my right hon. Friend knows, I do not agree with his assessment of Sir David Nicholson in this context. There was a systems failure that affected not only Staffordshire but the entire health service, and that lies very much at the heart of the problem. In my speech I will quote some statements made by Sir David at a conference a few months ago.

[Mr Hunt]

I obviously take on board what my hon. Friend says, but I want to move on to other aspects of the report.

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[Dr Phillip Lee (Bracknell) (Con)]

As ever, it is an honour to follow the hon. Member for Vauxhall (Kate Hoey).

Let me begin by congratulating my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing a debate about this important subject. It is a subject that I think should be debated more often in the Chamber, and I find it surprising that fewer Members wish to speak about it than have wished to speak about some of the other issues that we have considered since Christmas. I think all Members should reflect on that.

I believe that the core of this problem is responsibility: responsibility in public life. The general public are fed up—not increasingly fed up, but completely fed up—with hearing about scandal after scandal involving the national health service, the BBC, the newspapers and so on, for which no one takes any responsibility. No one walks. No one looks at themselves in the mirror in the morning and says “I did not do as well as I should have; I am paid a decent wage; the honourable thing to do is resign”—not “be sacked”, but resign.

I do not want to make a speech about Sir David Nicholson. Sir David Nicholson should know that he ought to resign. I cannot comprehend how he can think that his position is sustainable from a moral standpoint, but if no morality is involved, what about competence? He may have been head of the strategic health authority for only a relatively short time, but he was aware of the mortality rates when he was in that job. What did he do about it? If he did nothing about it, why is he still in post? However, I do not want to make this a personal issue.

Having worked in the national health service for 13 or 14 years, I do not need to be told about the problems caused by the culture in that institution. I learnt how it was as a medical student, and I saw it at first hand as a junior doctor. I want to say something about that, and also about competence in general. We need competent individuals in charge of our hospitals and on hospital wards, but I am not sure that we have had them in recent years. I also want to say something about responsibility in the light of that.

The national health service is a huge institution—some might say too huge—and because of its size, the fact that it has grown over the past 60 or 70 years, and the fact that the people who work in it rarely leave, institutionalised behaviour is rife. It is rife in medicine and in management. In my view, former Secretaries of State on both sides of the House display such institutionalised behaviour themselves. They may wish to reflect on that at the end of the debate.

The first debate in the House in which I spoke, apart from the debate during which I made my maiden speech, was a Backbench Business Committee debate about compensation for haemophiliacs. I was struck then by the institutionalised response from the Department of Health. It seemed plain that the Department did not want to set a precedent by doing what was obviously the right thing, namely compensating about 4,000 people and their families for what the system had done to them.

I am therefore not surprised by the Francis report, which those who read it will discover to be a not particularly impressive document. Parts of it have the ring of a Nuremberg defence. It is remarkable that individuals cannot be held responsible for their actions within a system. That system is apparently so perfect that no one within it needs to be good. I think that we need a health service in which individuals, including Secretaries of State, take responsibility for their decisions at every stage.

[Mr Cash]

Was my hon. Friend surprised, as I was, that neither of the Secretaries of State who were in charge at the time were called to give evidence to the inquiry? Did he find that very strange?

[Dr Lee]

I did find it very strange. In fact, I find the behaviour of both former Secretaries of State strange all round. There is a constant blaming of—

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[Mr Cash]

May I just correct one thing? The shadow Secretary of State was called to give evidence, but not the previous two Secretaries of State.

[Dr Lee]

I am talking about those who were Secretaries of State in the last Administration. In response to an intervention during his speech, the right hon. Member for Leigh (Andy Burnham) said, “I passed it on to Monitor.” The attitude that leads people to push away the process of decision making and take no responsibility for the outcomes needs to end.

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[Alan Johnson]

No, I am not giving way—at least not to the hon. Gentleman. I have heard enough.

This is what Francis said in paragraph 108 of his report:

“To place too much emphasis on individual blame is to risk perpetuating the illusion that removal of particular individuals is all that is necessary. That is certainly not the case here. To focus, therefore, on blame will perpetuate the cycle of defensiveness, concealment, lessons not being identified and further harm.”

So the man who knows most about what happened at Stafford hospital—and who was entrusted by this Government and their predecessors to conduct not one, but two, inquiries, and who in four volumes running to millions of words sets out what happened, why it happened and how it was allowed to happen—counsels against the very action that this motion appears to propose.

Francis identified who was accountable, and the Secretary of State was absolutely right: it was the chief executive, the chair and the board of the Mid Staffordshire trust. A number of clinicians are also held accountable for the appalling lapse in standards of care at Stafford. This accountability regime is set out in legislation approved by this House.

The Francis findings are consistent with those that emerged from the inquiry into the care of children receiving complex cardiac surgery at Bristol Royal infirmary between 1984 and 1995. In that case, five individuals at the hospital, including the chief executive, were the subject of adverse comments. In respect of both Bristol and Stafford, an argument was made to an inquiry that there was an extenuating failure of national policy. At Stafford, it was national targets; at Bristol, it was inadequate resources.

It is worth recalling the Bristol inquiry’s response. Sir Ian Kennedy said:

“The inadequacy in resources for PCS”—

paediatric cardiac surgery—

“at Bristol was typical of the NHS as a whole. From this, it follows that whatever went wrong at Bristol was not caused by lack of resources. Other centres laboured under the same or similar difficulties.”

We must remember that these were the days when one in every 25 patients on the cardiac waiting list died before they could be operated on, and when somebody with a serious heart condition could wait a year to see the cardiologist, three months to see the consultant and then 18 months to two years for the operation. That is why targets had to be introduced—to get a grip on this awful situation.

[Mr Cash]

I am astonished by the line on accountability that the right hon. Gentleman is taking. He was the Secretaryof State and I had a row with him at the time—and, indeed, with his successor—about the question of holding a proper full public inquiry under the Inquiries Act 2005. I wrote to him, too, and I did not get satisfactory answers under the guidelines laid down in the 2005 Act on the prime ministerial rules issued by the Cabinet Office.

[Alan Johnson]

On the question of a public inquiry, when Francis reported on his first inquiry, commissioned by my right hon. Friend the Member for Leigh, he made the point that it was about people affected being able to come and tell their story, and Francis said in his first report:

“I am confident that many of the witnesses who have assisted the inquiry in written or oral evidence would not have done so had the inquiry been conducted in public.”

It is very important that that first inquiry allowed people to come forward. The right hon. Member for South Cambridgeshire (Mr Lansley) may also well have been right to make the second stage of that a public inquiry, which was authorised because of one of the Francis recommendations, because we now have all the information, provided before a Queen’s counsel, about what happened there.

Francis is very clear about no blame being apportioned to any Minister. It is of course right for Ministers to be accountable if anyone knew what was going on and did nothing to stop it, or if something that was going on was a result of a Government edict or policy, but that was not the case at Stafford.

Targets had to be introduced to get a grip on this terrible situation of lack of access to health care. Targets did not cost lives; they helped to save lives. They were accompanied by the resources, the capacity and the political will that transformed waiting lists of 18 months to two years to a maximum of 18 weeks and an average of nine.

This is what Francis said about targets:

“It is important to make clear that it is not suggested that properly designed targets, appropriately monitored cannot provide considerable benefits and serve a useful purpose…indeed the inquiry accepts that they can be an important part of the health system in which the democratically elected Government of the day sets its expectations of providers who are funded by the taxpayer.”

The right hon. Member for Charnwood (Mr Dorrell) was absolutely right to say that long waiting lists have dogged the NHS since it was created in 1948. Rudolf Klein, the great historian of the NHS, says every Health Secretary shouted their orders from the bridge and the crew carried on regardless. Something had to be done to deal with that, and it was done.

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[Alan Johnson]

The principal point about targets is that they reduced waiting list times. They changed a situation in which people were dying while on waiting lists, which was a disgrace in a civilised country like ours.

The Francis report also gives no comfort to those who expected him to offer up Sir David Nicholson’s head on a plate. The irony is that they choose to make this attack on an NHS that is learning the lessons of Stafford and an individual, Sir David Nicholson, who has done more than anyone to make quality of care the organising principle of the NHS. I, like my three successors as Health Secretary, consider Sir David to be part of the solution, rather than part of the problem He is not perfect—none of us is—but he is a good public servant who is committed to the NHS, its patients and staff. If he knew what was going on at Stafford, or colluded in the awful events there, or if any of his edicts, policies or pronouncements were in any way responsible for what happened, I would agree with his detractors. No one knew what was going on at Stafford; not even the press, who pride themselves on fearlessly exposing wrongdoing. Not a single question was raised by local MPs in this House about what was happening at Stafford, and Francis has something to say about the way they passed on complaints.

[Mr Cash]

Will the right hon. Gentleman give way?

[Alan Johnson]

No, and I read the hon. Gentleman’s correspondence and it in no way drew attention to what was happening at Stafford.

[Mr Cash]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Please resume your seat, Mr Cash.

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[Mr William Cash (Stone) (Con)]

I believe strongly that we must not only look back properly at what happened at Stafford hospital but look forward. We must learn the lessons and we must ensure that what happens in future does not lead to the trauma experienced by the victims and patients in my constituency and those of my hon. Friends the Members for Stafford (Jeremy Lefroy) and for Cannock Chase (Mr Burley).

This is a debate about accountability and transparency and, as others have said, we also need a debate in Government time on the Floor of the House on the Francis report. On the question of accountability and transparency, I want to start with an issue that has not yet been properly considered in the debate: the role of the Secretary of State under national health legislation. Section 1 of such legislation clearly states the duties of the Secretary of State, and always has done. I was astonished, as I made clear at the time, when the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) left out that part of the question of accountability.

I have been involved in the history of this case. As the Member of Parliament for Stafford from 1984 to 1997 and the Member of Parliament for Stone from 1997 to the present day, I have had many constituents, including Debra Hazeldine, a prominent member of Cure the NHS, who have played an important role in drawing attention to these matters. I have worked closely with them over the whole of this period.

Contrary to what the right hon. Member for Kingston upon Hull West and Hessle said—I imagine it must have been a serious slip of memory—I wrote letters to him. Ministerial guidelines from 2005, issued by the Cabinet Office, set out in great deal what must happen when a Member of Parliament writes to a Secretary of State. He must receive a personal reply. I do not need to go into the full details now, but only the other day I asked the Minister for the Cabinet Office and Paymaster General to reaffirm the contents of those guidelines, which are still applicable.

There are only 650 of us, and serious matters can arise from the complaints we make. I am talking not about the complaints procedure of the national health service but about a Member of Parliament going to the Secretary of State to raise a specific question, usually enclosing correspondence from a constituent, and asking for action. In my case, I said that the matters I raised were both serious and urgent and that they required the personal attention of the Secretary of State. I have not the time to go into the detail, but successive Secretaries of State simply did not take the kind of action that I would have expected following those letters.

[Alan Johnson]

This is a fascinating subject and I am willing to have a look at any correspondence between the hon. Gentleman and me when I was Health Secretary. I certainly tried very hard to correspond with all Members of Parliament. Does he accept what Francis said:

“Local MPs received feedback and concerns about the Trust. However, these were largely just passed on to others without follow up or analysis of their cumulative implications…They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare”?

We all have lessons to learn from the Francis report; does he accept that he has lessons to learn, too?

[Mr Cash]

We all have lessons to learn about all matters relating to these questions, but the guidelines also talk about the necessity of chasing and following up in the Department. It is probably a question of the correspondence unit in the Department and the private office. There was a failure and the Francis report made it absolutely clear that the guidelines were not complied with and were not operated effectively. I am sure that the right hon. Gentleman, on reflection, will recall that that was what the report said.

I referred to these matters in my witness statement, and Una O’Brien, the permanent secretary at the Department of Health, also made it clear in her evidence that if such letters were received now, they would receive an immediate response, irrespective of whether the hospital was a foundation trust or not. The bottom line is that there was a failure within the Department and by successive Secretaries of State. The shadow Secretary of State acknowledged in his evidence that he looked at these letters. I will not dispute that. However, not only were the matters not dealt with satisfactorily, but I cannot absolve the Secretaries of State from their failure to agree to the 2005 Act inquiry.

I do not need to rehearse the history of the case. I asked not once, not twice, but repeatedly, and I had to urge and persuade the shadow Secretary of State at the time and also—I am glad that, to his great credit, he decided to do so—the present Prime Minister who, as Leader of the Opposition, decided in the light of my representations and no doubt those of others to have the 2005 Act inquiry. Without that we would not be discussing the Francis inquiry—the present one, not the previous one, important though that was—and the others. They were Government inquiries, but they did not do the job in the way the present inquiry did.

[Andy Burnham]

I am listening carefully to what the hon. Gentleman is saying. It is not strictly true to say that that was a Government inquiry. I brought in Robert Francis—will he acknowledge that?—in July 2009 to conduct an independent inquiry. As my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) said, in presenting his findings Robert Francis said that he felt that more people had come forward because of the nature of that inquiry.

[Mr Cash]

I will let the matter rest at that point for the present purpose.

I move on to the next question of accountability, with respect to Sir David Nicholson. I referred to Sir David in a number of debates way back as far as 2009. I also referred to him in my evidence to the Health Committee, in my witness statement and in correspondence with the Francis inquiry. In my judgment, for the reasons that I have already given, there was a systems failure with respect to this whole terrible tragedy, not only in relation to Mid Staffordshire, but more generally.

We need to turn a new page. I am not saying that Sir David should receive a P45 now. What I am saying is that, sooner rather than later, it is essential that he departs his post. I disagree with the Secretary of State and therefore also, I admit, with the Prime Minister on this matter, and so do many others. Accountability must mean what it says, and in this context it means carrying the can. The whole saga took place on Sir David’s watch, even though he was not at West Midlands for more than a certain time, and the problems that have arisen carry with them issues of accountability.

I acknowledge that Robert Francis referred to scapegoats. It is not, as has been said before and I repeat, a question of blaming scapegoats. It is a question of responsibility and where it lies at the time. In my judgment it did not lie only with the Secretaries of State of the time. In fairness, they have apologised.

I conclude with a statement made by David Nicholson at a conference that took place a few months ago. He made it clear in that statement that he took personal responsibility for what had happened. It is very important that we recognise that he has apologised and that he has made a statement that is clearly an admission that he lost the plot when, as he put it, ward 10 in Mid Staffs was under severe stress. That is the problem and I believe he has to go.

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[Dr Sarah Wollaston (Totnes) (Con)]

I want to start by thanking the vast majority of staff in the NHS, who go to work every day motivated to serve their patients and deliver world-class care.

We should not think that we can just return to the halcyon, storm-free days of the 1970s, when NHS care was perfect. Before I started medical school, I worked as a nursing auxiliary, which would now be called a health care assistant, in what was then known as a geriatric hospital. I have no wish to return to the days of vast, mixed wards and a rather authoritarian approach to care. I would far rather the NHS of today than that of the 1970s.

However, the mantra that the NHS is the envy of the world sometimes gets in the way of providing decent feedback and criticism when things go wrong—and after listening to the words of the right hon. Member for Cynon Valley (Ann Clwyd), who could say that things do not go wrong? The failures at Mid Staffs, and the fact that more than 1,000 people died in a single hospital, are truly shocking. Robert Francis told the Health Committee that he had spent three years of his life “listening in horror”—how shocking! It is hard to imagine any other institution or organisation where death on that scale would not have led to prosecutions, yet too often in the NHS it is not prosecutions that follow but promotions, just as it was in this case.

It has, unfortunately, become something of a heresy to criticise the NHS, and my comments are not to be interpreted as criticising the vast majority of staff, but rather as a means of considering how we can help those staff and their patients. It is vital that NHS staff are free and feel safe to raise concerns. This week, at a meeting in the House that I was chairing, Robert Francis spoke about “complaints being a gift”, but that is not the experience of staff or patients within the NHS.

The Health Committee conducted an inquiry into complaints and litigation in the NHS that reported in June 2011, and I wish to read from the chilling evidence that we heard from Nicola Monte. She spoke of her experience of being barrier-nursed in Stafford, and said that a nurse came into her room and berated her saying, “I have been off sick because of you complaining about me. Do you realise the suffering you have caused me?” Too often, staff end up feeling that they are victims because—as they know—they are often scapegoated for what are system failures, often by management. That runs throughout the NHS; the response to complaints is defensive and dismissive and that must change if we are to implement what Robert Francis rightly recommends as a new culture change of openness, transparency and candour within the NHS.

I hope, however, that no one will think that introducing a statutory duty of candour can be a single approach. That will not work without a culture change that supports and welcomes complaints as a “gift” to identify problems and improve care. I hope the Government will implement in full the recommendations made by Robert Francis so that complainants are regarded not as the problem but as part of the solution.

I particularly welcome the Secretary of State’s announcement that gagging clauses are to be outlawed with immediate effect throughout the NHS but—I hope he will not mind my saying this—that must extend to the top of the system. Would the Secretary of State feel it appropriate for David Nicholson’s secretary to have the following clause in his or her contract:

“That they should avoid associating themselves with recommendations critical or embarrassing to the NHS commissioning board”?

I think we would find that wholly unacceptable, yet, if I may refer Members to the ministerial code of conduct, the Secretary of State’s Parliamentary Private Secretary, who is not a member of the Government, has exactly that clause within his contract. That is something we have to change because the culture of the NHS must extend from the Department of Health to the nursing auxiliary—or health care assistant—at the bedside, and to patients so that they and those around them feel safe and able to raise complaints.

[Mr Cash]

Is my hon. Friend aware that Public Concern at Work, to which I referred in my witness statement on Stafford hospital, has played a big role in highlighting whistleblowing and has set up a commission to look at that issue? The outlawing of gagging clauses should apply not only on severance, but also—emphatically—when people are in post so that they can be properly protected when acting in the public interest.

[Dr Wollaston]

I absolutely agree. This is about starting to identify the culture and values of the people we employ in the NHS, and making it clear that not only does everyone in the NHS have a duty to bring forward concerns, but that those concerns will be welcomed and acted on. I would like everyone in the NHS to have an individual to whom they can go and feel safe in raising their concerns. I thank my hon. Friend for raising that point.

My hon. Friend the Member for Reading East (Mr Wilson) has told me that he does not feel that he has been gagged, which is great, but there is still an important point of principle: as a PPS, he is not able to speak in this debate. We want everyone, from the very top of the NHS and the Department of Health, right through to the bottom of the system, to feel that they are fully free to raise any concerns they have, wherever they may be.

After the Bristol heart scandal, whistleblower Stephen Bolsin was asked how we could prevent this from ever happening again. He said:

“Never lose sight of the patient.”

His whistleblowing cost him his career. He first raised the alarm in 1989. His work over six years to raise his concerns remains one of the single most important improvements in clinical outcomes in the NHS—that is how important whistleblowers are to our system. Yet the scandals keep happening. Would it not be a tragedy if, five years from now, we were still saying, “We need to put patients at the heart of everything we do in the NHS”? It is time to make that happen.

--- Later in debate ---

[Mr Cash]

In a conference on 4 October 2012, I understand that Sir David Nicholson said that

“the senior leadership of the NHS and I was part of it in those circumstances”

but “lost the plot”. He continued:

“We lost the reason why we were there. We got so excited about…changes”,

but he went on to acknowledge that

“on ward 10 in Mid Staffordshire Hospital really bad things were happening”.

That is the sort of admission that he had to make in those circumstances. Does my hon. Friend agree that that amounts to admitting responsibility for the system’s failure?

[Stephen Barclay]

I do agree with my hon. Friend, and that does seem at odds with the Government’s welcome commitment to promoting individual accountability. In response to the Robert Francis report, the Prime Minister talked about three fundamental problems with the culture of the NHS. Of course that went beyond one individual.

I am concerned about the timing of the announcement of the appointment of Barbara Hakin, a close ally of Sir David Nicholson. It is important to note that she is innocent of any allegations being made against her, but I understand that she is under investigation at the moment. The timing of the appointment, then, seems strange. I invite my right hon. Friend the Secretary of State to intervene to clarify whether he was told of Barbara Hakin’s appointment prior to it being made. If he was not told, does not that say something about the power that Sir David wields within Richmond House?.

A further issue is whether Parliament knows the quantum or scale of the payments made to whistleblowers. I have repeatedly raised this matter over the last two years and was finally given a figure of £15 million paid over three years—silencing quite a lot of people. It now emerges, however, that that is not the whole story, as it does not cover payments such as the one for Gary Walker, which was paid through judicial mediation.

As seen in the NHS manual for accounts, each NHS body or trust is required to compile a register detailing all special payments made, including those through mediation. As I understand it, even the Department of Health does not know how many such payments have been made—and that applies to the Treasury, too. In a response to my parliamentary question this Tuesday, the Minister said:

“Approval has not hitherto been required by the Chancellor or the Secretary of State for Health for special severance payments made as a result of judicial mediation. However, as of 11 March”—

this Monday—

“approval will be required.”—[Official Report, 12 March 2013; Vol. 560, c. 182W.]

The position seems to be moving as of this week. Parliament does not know how much has been paid to whistleblowers, so will the Minister clarify when we will know?

In my Adjournment debate of a week last Monday, my hon. Friend the Member for Bracknell (Dr Lee) asked whether the chief executive of Mid Staffs was subject to a gagging clause. We received a welcome reassurance that we would be given an answer, but when we were on our way to the Chamber for this debate, my hon. Friend told me that he had received none. I hope that the Minister will clarify whether Mr Yeates was subject to a gagging clause.

--- Later in debate ---

[Steve Baker]

Of course I would rather that the money was spent on standards and performance and not on prosecutions, because I would rather the problems did not occur. I do not wish to lecture the right hon. Gentleman, and I feel sure he did not quite mean it this way, but if we do not intend to apply the law of corporate and individual gross negligence manslaughter, let us repeal it, or amend it so that it does not apply to the NHS. I have to say to the right hon. Gentleman that it does apply to the NHS and that in certain cases, as Francis has said, things are so bad it should be applied.

I ask the Government to look at democratic control. I am delighted that the Secretary of State is reforming the Care Quality Commission, but how can we make sure that there is more direct accountability, perhaps to the health and well-being boards, and the overview and scrutiny committees? How can we give them the power to sanction or perhaps even, through due process, dismiss a board or a chief executive?

I think here of Paul Ryan, a man with vascular disease who had lost one leg already when he found himself sick. He had four days of GP visits and spent nine hours in accident and emergency on a Friday. He was then sent home, having had an MRI scan, after which he was expecting to lose his leg on the Monday. He was told to expect a phone call, but no phone call came. The Ryans eventually called 999 and were told that it was better to get a GP. The GP arrived and called an ambulance. It took two hours for that to arrive and Paul Ryan died in the ambulance with his wife on the way to hospital.

[Mr Cash]

Does my hon. Friend agree that accountability does reside also with the Secretary of State, as set out in the national health service legislation? That is essential in relation to our functions in this House and those of this Secretary of State and former Secretaries of State.

[Steve Baker]

I am grateful to my hon. Friend for his point, although it has been examined at length, so I do not want to go down that rabbit hole with him—I hope he will forgive me.

The post-mortem on Mr Ryan indicated that he probably would have suffered the same fate in any event, but the system let the Ryans down—Mrs Lyn Ryan made that point to me and to the local newspaper. Unfortunately, the case plays right into the fears of the public in Wycombe, because we lost our accident and emergency facility in 2005 and we recently lost our emergency medical centre. We have just had two similar repeat occurrences of the minor injuries unit failing to refer people across the car park into the excellent cardiology and stroke units. We have seen an enormous range of little problems, for example, an 85-year-old lady with dementia was sent home in a taxi at 2 am in just her hospital gown. This cannot go on, and the public’s concerns are justified. The trust is being investigated by Sir Bruce Keogh and although I have heard good reasons why its mortality levels are justified—they relate to running hospice care, in particular—this must be taken as an opportunity to improve things.

Finally, I wish to make a point on transparency. Yesterday, I spoke to Anne Eden, the chief executive of the trust. I am not going to put on the record the entire content of the conversation, but when I told her that I intended to raise this issue of corporate manslaughter on the radio this morning, I was told, in terms, “To protect the reputation of the Buckinghamshire trust, legal action would be sought.” This is a matter of public interest being raised by a Member of Parliament in good faith, but I have had to—[Interruption.] To be fair to her, she was talking about the radio. But I have had to rely on privilege to protect myself from being sued on this matter. It is not acceptable that such a matter should have to come to a Member of Parliament, simply to rely on privilege. The situation reinforces something I have experienced again and again since becoming an MP: second-hand rumours and half-truths about the state of health care in Buckinghamshire. I have encountered: people stymied; people thinking it is helpful to give half a rumour to a friend to repeat to me so that I can know how bad things are; and people’s frustration at not being able to do anything. I know that Buckinghamshire Healthcare NHS Trust is obviously close to your heart, Mr Speaker. I know that it expects to satisfy Sir Bruce Keogh, but it is really time for proper accountability and that must include the courts.

Induced Abortion

William Cash Excerpts

Wednesday 31st October 2012 Westminster Hall

[Mr William Cash (Stone) (Con)]

I admire what my hon. Friend has done and the determination and courage that she has shown against enormous opposition.

[Nadine Dorries]

I thank my hon. Friend for that intervention. I am very flattered.

Due to the fact that the 1967 Act is so little discussed and its format is so archaic, over the past year we have seen a number of abortion providers flout the law. One of the reasons for that is that Parliament itself shows no respect for the law. In the past year, abortion clinics have been exposed using the law creatively to offer abortion illegally and criminally based on the gender of the pregnancy. In fact, the Care Quality Commission and the General Medical Council are now investigating, I believe, 14 cases of malpractice, and arrests have been made at other clinics. The Calthorpe clinic in Birmingham has been closed down and handed over to another provider.

Those cases point to an erosion of respect for the law by abortion providers. The culture of fear in Parliament, which is held by many MPs, on discussing abortion law has contributed, or may have contributed, to the situation. That has to stop.

health

William Cash Excerpts

Tuesday 18th September 2012 Commons Chamber

[Dr Poulter]

As my hon. Friend is aware, there is a process for scrutinising all decisions and, as I have outlined, if the correct procedure has not been followed, decisions are open to judicial review. To reassure hon. Members, we have accepted, from a medical perspective, the principle that fewer units deliver better care for patients and better surgical results for children. Therefore, this review is not about closing units in any particular hospital, but about specialist surgical services. Day-to-day care of patients and paediatric care for those who have had surgery will continue locally even after this review, and that should reassure local patients.

[Mr William Cash (Stone) (Con)]

Will the Minister give way?

[Dr Poulter]

I will give way again, but I am mindful of the time.

[Mr Cash]

On that point, and in the light of the way this legislation has been redressed over the past year and half, does the Minister accept that before the legislation was introduced, and now, ultimate responsibility and accountability for all matters affecting the health service turned on the duties, accountability and statutory responsibilities of the Secretary of State? That is why the Minister is now at the Dispatch Box, just as the Secretary of State would be in other circumstances.

[Dr Poulter]

I accept that the Secretary of State has always had responsibility for the health service, and that was implicitly made clear in the Health and Social Care Act 2012. It is, however, important that we no longer have a system in this country that micro-manages the delivery of local health care services. We must listen to local doctors and nurses, and put them in charge of the configuration of local services because they are often the best advocates for the needs of local patients. Reconfiguring local services should be led—as per the four tests I outlined previously—on good clinical grounds where there is a clinical case for reconfiguration and where local communities have been consulted. That is something we should listen to and we must move away from the Whitehall micro-management of local health care delivery.

EU Working Time Directive (NHS)

William Cash Excerpts

Thursday 26th April 2012 Westminster Hall

[Charlotte Leslie]

I find it shocking and outrageous that that is allowed to happen. Its importance cannot be overestimated. Lives are being put at risk because of Brussels bureaucracy that does not even begin to protect the workers whom it says that it is designed to protect. This is one of the most important issues in the NHS, and I urge the Minister to do everything possible to work with colleagues in the Department for Business, Innovation and Skills to sort it out.

To return to the point about the flu pandemic, many people say that things will be okay because the 48-hour week is an average that can be measured over six months; so if there is a pandemic everything will be fine, because the doctors can sort it out and go back to normal afterwards. Well, if the pandemic were to last more than six months, I do not know where that would leave us. If it were to last less than six months, we would not have any doctors able legally to perform routine functions. That demonstrates how rigid, bureaucratic, badly thought-through and frankly dangerous the directive is.

The cost, however, is not only human: it is financial, and it is massive. Colleagues are concerned about the closure of their constituency hospitals and the ability of those hospitals to find coverage. Hospitals are floundering and struggling to find staff for an ever-increasing demand on the NHS. Let us not forget that the restriction on staff is happening at a time of unprecedented demand on our health system. Stafford hospital closed its accident and emergency department in the evening because it could not find cover. Other hospitals are taking other measures and spending exorbitant amounts of money on temporary staff to fill the gaps. Many colleagues will have read about the £20,000-a-week temporary doctor who was brought in to fill the gaps. Hon. Members will be shocked to learn that a staggering £2 billion has been spent in the past two years on temporary staff in the NHS. If we think about the financial challenges that the country faces and where else that £2 billion could have been better spent, that figure demonstrates how crucial the issue is. One hospital trust spent £24 million on temporary staff because of the staffing problems caused by the directive.

As I have hinted, the grim irony is that, for all the contortions and scheduling arrangements that hospitals, doctors and trusts go through to accommodate the directive, it is not even doing what it was supposed to do and make the work-life balance for doctors better. I received an e-mail from a junior doctor who is soon to get married and wants to spend time with his fiancée and plan his wedding, and who is frantic, not only about the erosion of his training and his future professionalism, but also about the destructive influence of the directive on his home life and his work-life balance. He writes:

“The directive certainly hasn’t made any impact on quality of life. Having worked 60-70 hours a week, now doing 48 hours, I am no less tired...the stated aims of improving work life balance and improving training are farcical.”

Then he goes on to talk about the realities that junior doctors face. He says:

“There is simply not enough time in the 48 hour week to get trained, particularly in the craft specialities, so we all go in on our days off. If we don’t, we don’t get trained and it is us, our careers, and ultimately the patients who suffer. Training used to happen in our official working hours, now we work just as hard, but get trained in our time off, and don’t get paid.”

And he is not alone. The Association of Surgeons in Training reported similar exhaustion because of the directive, and the Royal College of Physicians, as I have already mentioned, reported soaring sick leave since it was introduced.

I have spoken to junior doctors who report worrying signs of things to come. Given the contortions of shift working under the directive and the changes to on-call working time, junior doctors increasingly report that they are reluctant to specialise in disciplines that have more arduous on-call demands and require presence at the hospital, such as acute medicine, general surgery, obstetrics, gynaecology and anaesthesia. An unofficial straw poll of senior house officers in one city showed that they nearly all did everything they could to avoid being on the acute register because that was such a nightmare. They just thought, “Why would we?”

Statistics showing the number of applications and the number of positions available in those disciplines suggest that junior doctors who report such trends are not wrong. We are beginning to see our most talented doctors moving away from the disciplines that put the most stress on their work-life balance because—let me stress this—of the directive. When making lifestyle choices, doctors are looking at those specialist disciplines and thinking, “Why would I go into that?” which is extremely worrying for the future of our NHS provision. We have to stop that trend before it becomes more cemented.

[Mr William Cash (Stone) (Con)]

My hon. Friend is making a most compelling speech on a matter of extremely great importance. Does she recognise the problem that everything that she has said stems from a system that is based on treaties and backed up by the European Court of Justice? Therefore, we cannot make changes unless we renegotiate the treaties. In a matter of such importance, will the Minister make the necessary adjustments to achieve the objectives sought by my hon. Friend and ensure that we get a result?

[Charlotte Leslie]

I thank my hon. Friend. He has done a tremendous amount of work in this area, and I bow to his expertise. I see the solution as twofold and two-speed. First, we must ask why we are in this situation, and we must look at the treaties. Open Europe has suggested an interesting double-lock mechanism for negotiating our way out of what was the social chapter and creating a situation in which we are not bound by the rulings of the European Court of Justice. Those are big, radical steps and will take time, but it is something that we should look at.

This issue is of great importance on a daily basis. Each year that passes, a new generation of doctors enters a system that is systematically undermining the most important element of our NHS. Because issues to do with Europe are so tangled, difficult and frustrating, we need to look at more practical and instantaneous ways of getting around the directive with which we are inflicted. I take my hon. Friend’s point, but a two-speed approach is vital because of the issue’s importance.

Stafford Hospital

William Cash Excerpts

Tuesday 20th December 2011 Westminster Hall

[Mr William Cash (Stone) (Con)]

I will be fairly brief. I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing this debate. Since becoming the Member of Parliament for Stafford, he has transformed the attitudes and policy towards Stafford hospital. I pay tribute to the work that he does on behalf of the hospital and all his constituents. The issue has a direct bearing on my constituency, as well as those of my hon. Friends the Members for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson). Indeed, it also has a bearing on other parts of Staffordshire where the hospital is used by constituents from neighbouring areas.

I endorse everything that my hon. Friend the Member for Stafford has said, but I should like to add another factor, which is highly relevant to a constituency such as mine. The Stafford part of my constituency has some deeply rural areas, such as High Offley, that are very much more remote than the streets of Stafford and other towns with good arterial connections to the M6. I have heard figures quoted about how quickly people can get to UHNS and other hospitals. I simply make the point that somebody might have a stroke, or a farmer might be caught in some dreadful tragedy in a dark field in a remote area.

My hon. Friend is completely right when he says that we need a full accident and emergency service. At the moment, we are going through a hiatus, but let it not remain long because we need a proper full service, especially for those deeply rural areas, as well as for the more built-up areas in the urban parts of Stafford and the adjacent areas.

[Mr Philip Hollobone (in the Chair)]

Order. This debate is clearly important for Stafford and the surrounding area. I call the Minister to respond.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Thank you very much, Mr Hollobone, for calling me to respond to the debate. It is a pleasure to serve under your chairmanship today; I do not think that I have done so before.

I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing this debate and of course I join him in paying tribute to the staff of Stafford hospital, the staff of the local ambulance service and indeed the staff of the neighbouring hospitals for all that they are doing to provide local people with good accident and emergency services. I particularly pay tribute to them at this time of year. When many people will be enjoying their Christmas lunch, there will be many NHS staff working over the Christmas period and it is always important to acknowledge their contribution and the work that they do.

My hon. Friend raised a number of issues about the overnight closure of the A and E department at Stafford hospital, which is a measure that will naturally be a cause for concern for his constituents. I know that all of them have been through quite a tough time, but I also know that he will agree—in fact, he did agree—that the safety of patients must always come first. However safety can be protected, that is always the best course of action, so I must support clinicians at Stafford hospital in their request for the overnight closure, which they made so that standards of care in the A and E department can be kept high.

My hon. Friend mentioned A and E staff, but it is also important to note that this issue is not always about numbers. A certain number of staff are needed in an A and E department, but that department also needs expertise; it not only needs staff in the right quantity but staff with the right skills and competencies.

I also want to remind hon. Members who are in Westminster Hall today—it is a pleasure to see so many of them here—that for some time now the NHS at Stafford hospital has been routinely diverting all of the most critical patients, including those suffering from major trauma, heart attacks and strokes, to the larger hospitals to the north and south of Stafford. That is not because of the suspension of overnight A and E at Stafford but because the larger hospitals in the area are better able to cope with life-threatening emergencies. My hon. Friend pointed that out, but it is worth repeating it for the record.

The change at Stafford A and E is down to staffing levels; I understand that financial pressures do not come into it. Mid Staffordshire NHS Foundation Trust has the funding for the posts that it needs to fill, but it has found it difficult to find the staff to fill them. My hon. Friend mentioned the importance of reassuring the local community. The available health services need to reassure people; that is one of their important roles. They must also engender trust among those people who they are there to serve. That is a very important role that the NHS must play.

Since the summer of 2010, permanent staffing—both medical and nursing—at Stafford A and E has been low. The trust and the wider NHS in the midlands have been trying to get enough medical cover to keep standards at the right levels. It is also important to acknowledge the support from the neighbouring University Hospital of North Staffordshire. Without it, the situation would have been considerably worse. However, that regional support could never be kept going indefinitely. To buy some time to work out longer-term solutions, Sir Bruce Keogh, the NHS medical director, arranged the short-term loan of four members of staff—two doctors and two nurses—from Defence Medical Services to help at the trust. My hon. Friend paid tribute to those staff and it is always good to see organisations working together to deliver the best possible solutions for patients. As my hon. Friend pointed out, that arrangement started on 17 October and it is now coming to an end; again, it could not be kept going for an indefinite period of time. However, let us place on record our thanks to the members of staff involved and to the DMS for providing them. I know that everyone at the trust welcomed the expertise that the DMS staff brought with them.

In October, the Care Quality Commission issued a warning notice regarding the quality of care provided by the Stafford A and E department. The CQC’s concerns centred on nursing staff levels, which at the time of inspection were badly depleted because of staff sickness and the overall difficulty of filling vacancies. On 9 November, the trust decided to close its A and E department overnight, starting from 1 December. That decision was not made lightly. As my hon. Friend pointed out, people want A and E facilities close to where they live, so, as I say, such decisions are never made lightly, and they need to be taken locally; it is not appropriate for the Department of Health to interfere with them. It goes without saying that the trust is paying the closest possible attention to the situation at Stafford A and E. It believes that that situation cannot be improved quickly, however frustrating that is for hon. Members.

[Mr Cash]

Does the Minister agree that there is also a question that may be a national issue, of which Stafford may or may not be an example? That is the need to ensure that consultants are always available, as and when necessary, because I think that that issue is all part of the hierarchy of the problem.

[Anne Milton]

Yes, and I thank my hon. Friend for raising that important issue, which is one of delegation and cover. It is of concern to the Department of Health; I think that there have been a number of newspaper articles and some television programmes about it. It is important at all times that care is delivered safely. That sometimes requires cover, but it also requires appropriate levels of delegation. However, what must be uppermost in everybody’s mind is that patients’ safety is always preserved, and the Department of Health will obviously work with the NHS to ensure that nationally we have schemes to ensure that patients’ safety is maintained.

For that reason, it would be unwise to return to 24-hour opening at Stafford A and E department before it is safe to do so. To minimise risk, I understand that the trust has set criteria that must be met before overnight operating can resume, and I also understand that there are regular staff meetings to check progress against those criteria. Those meetings are an important means of reassuring staff and those criteria will become critical. They mean that staff will be aware of the current situation and fully up to speed with the progress that is being made.

At present, I understand that patients needing A and E treatment are being diverted by ambulance to A and E departments in Wolverhampton, Walsall, Burton and Stoke, every one of which has been fully involved in planning for the overnight closure at Stafford. West Midlands Ambulance Service has established a divert policy to deal properly with patients coming to the trust, and to alternative A and E departments, at night. To help to manage those arrangements, the trust has appointed a “repatriation co-ordinator” to ensure close co-operation between Mid-Staffordshire NHS Foundation Trust hospitals and the other hospitals affected. The thing that struck me as quite extraordinary is the amazing job titles that the NHS can come up with at times. However, that “repatriation co-ordinator” will be important, to ensure close co-operation between hospitals.

To date, very few patients have turned up at Stafford A and E at night, which is a testament to how well the trust has publicised the current arrangements. That is another important point; explaining the reason for the closure, and how and where to get help when Stafford A and E is closed, is vital. My hon. Friend the Member for Stafford mentioned older people in his speech. As I say, the fact that few people are turning up at Stafford A and E at night means that the message that the department is closed overnight has got through, even to older people, who of course often attend A and E departments.

[Mr Cash]

On a purely practical level, diversion signs are important. My hon. Friend is referring to the importance of getting the message through, but however much we try to get the message through, I suspect that people will still turn up anyway. Therefore, the most important thing at that point is to know that the signing system—as provided by the highways authorities, or whoever—will actually provide the right information to help people to get to the other hospitals. Does my hon. Friend agree?

[Anne Milton]

I agree entirely, and I am sure that my hon. Friends the Members for Stone (Mr Cash) and for Stafford are in touch with the local authorities, because it is extremely important, as my hon. Friend the Member for Stone rightly pointed out, that diversion signs are clear to people and that people do not turn up at an A and E department that is closed. It is actually quite extraordinary how resilient people are to those diversion signs. Information needs to be given to people in words of one syllable, so that they are quite clear that the A and E department is not open for business at the moment.

Stafford is taking, and it will continue to take, GP-referred maternity, paediatric and medical patients 24 hours a day, seven days a week, which will be of some reassurance to local people. I know that my hon. Friend the Member for Stafford has visited Stafford A and E department several times since the overnight closure came into effect, and I am pleased to hear that he is satisfied that the measures that have been put in place will ensure patient safety and good access to A and E services. I know that some of his constituents are concerned about the impact of increased demand on neighbouring A and E departments. The situation is being closely monitored and the local NHS is content that the arrangements are working well.

Of course at this time of year, the pressure on A and E departments gets greater. We have not suffered particularly severe weather in the south of the country, but some places have done so. Such weather always takes its toll on the NHS, and therefore the monitoring of how things go is very important.

As I have said, the closure took place on the advice of clinicians with the aim of ensuring patient safety. The trust continues in its efforts to recruit additional staff, and patients can be assured that it will not reopen its A and E department full time before it is safe to do so. The trust, the Staffordshire PCT cluster, emerging clinical commissioning groups and others are looking at a range of options to achieve a clinically safe and financially sustainable service, and will present their report on the way forward to the NHS Midlands and East strategic health authority cluster at the end of January next year.

I will say a word about emergency medicine nationally. The number of emergency medicine consultants has risen by more than half in the past five years, but we agree that it must continue to increase and we are working with the College of Emergency Medicine on how best to make that happen. In the short term, some trusts have been employing more GPs in A and E. GPs are primary care experts, so their presence in A and E allows emergency specialists to concentrate on the cases for which their skills are needed. We are, however, looking at a number of areas, because this matter is of national concern. We are considering revising the person specification for training in emergency medicine to make entry more accessible, and redirecting into emergency medicine some of the doctors who cannot secure other higher specialty training posts.

My hon. Friend the Member for Stafford pointed out the importance of specialist services, and what I have said about the national situation highlights exactly why they are so important. As my hon. Friend the Member for Stone mentioned, the particular needs of people in rural communities, for whom travelling long distances causes additional problems, must also be taken into account. It has long been the case that specialist services need to be provided in specialist centres, and during my own working life as a nurse we had regional neurosurgical centres for the specialties that required highly skilled and specific care. That is important, because we are always balancing patient safety with the accessibility of local services.

Health and Social Care (Re-committed) Bill

William Cash Excerpts

Wednesday 7th September 2011 Commons Chamber

[Paul Burstow]

We have had a full and wide-ranging debate on the many issues covered by this group of amendments. I want to try to pick up a few of the key questions that have been asked. The Bill will increase the Secretary of State’s accountability for a comprehensive health service.

[Mr William Cash (Stone) (Con)]

Will the Minister give way?

[Paul Burstow]

No, not at all.

The Bill will provide all the powers and duties necessary: the duty to keep the health service’s functions under review, a duty to report annually on the health service’s performance and a duty to consult on the board’s mandate and to lay it before Parliament and to lay regulations about how commissioners carry out their functions. All those things are new. They are more than backstops; they are guarantees of a comprehensive health service being secured and the Secretary of State maintaining his accountability to the House and Members of Parliament for that purpose.

I have already made it clear to those who are concerned about clause 4 and the possibility, which we do not accept, that it will lead to a hands-off approach that we are willing to listen to and consider the concerns that have been raised and make any necessary amendment to put it beyond doubt that the Secretary of State remains responsible and accountable for a comprehensive health service, which we all want to see.

There has been talk about a postcode lottery. Indeed, the Bill sets out, through the work of the NHS commissioning board, to ensure that the postcode lottery that we inherited from the last Government is something that we can make a thing of the past, as a consequence of the changes that the Bill will introduce.

The hon. Member for Stoke-on-Trent North (Joan Walley) made some important points about environmental health officers and the contribution they make locally and nationally. Although we see the chief medical officer having a key role in providing such advice, I would be happy for us to carry on discussions about how we can further strengthen that role nationally.

As the consultations on the issues raised today by my hon. Friend the Member for Cheltenham (Martin Horwood) carry on, I am certainly happy to discuss with him how we can address those concerns. I can assure him that, because the Secretary of State will be directly involved in the appointment process for directors of public health through Public Health England’s role, they will be able to assure themselves that they are adequately qualified.

[Mr Cash]

Will the Minister give way?

[Paul Burstow]

No.

The Bill has been changed because the Government have been listening carefully. We have acted on the NHS Future Forum’s recommendations.

Our goals are clear in this Bill: they are to place patients at its heart, ensure that the service is clinically led and ensure that it is focused on driving up quality and outcomes.

Question put and agreed to.

New clause 1 accordingly read a Second time, and added to the Bill.

--- Later in debate ---

[Mr Lansley]

If my hon. Friend will forgive me, I will not give way because other Members wish to speak on Third Reading.

In Wales, a Labour Government are cutting the budget for the NHS. The coalition Government’s commitment to the NHS will not waver. The Government and I, as Health Secretary, will always be accountable for promoting and securing the provision of a comprehensive health service that is free and based on need, not ability to pay.

What matters to patients is not only how the NHS works, but, more importantly, the improvements that the modernisations will energise—a stronger patient voice, clinical leadership, shared NHS and local government leadership in improving public health, and innovation and enterprise in clinical services. Everyone will benefit from the fruit that the Bill and the reforms bring. There will be improved survival rates, a personalised service tailored to the choices and needs of patients, better access to the right care at the right time, and meaningful information to support decisions. The Bill provides the constitution and structure that the NHS needs to work for the long term.

Patients know that it is their doctors and nurses—the people in whom they place their trust—who make the best decisions about their individual care. The Bill is about helping those people to become leaders. It is not about turning medical professionals into managers or administrators, but about turning the NHS from a top-down administrative pyramid with managers and administrators at its zenith into a clinically led service that is responsive to patients, with management support on tap, not on top. It is about putting real power into the hands of patients, ensuring that there truly is “no decision about me without me”. My only motivation is to safeguard and strengthen the NHS, and that is why I am convinced that the principles of this modernisation are necessary.

Of course, the Bill has been through a long passage. There have been questions and new ideas, and many concerns and issues have been raised. We have done throughout, and will continue to do, what all Governments should do—listen, reflect, then respond and improve. The scrutiny process to this point has been detailed and forensic. There were the original 6,000 responses to the White Paper consultation, many public and stakeholder meetings and 28 sittings in Committee, after which the hon. Member for Halton (Derek Twigg) acknowledged that “every inch” of the Bill had been scrutinised, but we were still none the less determined to listen, reflect and improve.

I wish to thank the NHS Future Forum, under Steve Field’s leadership, for its excellent and continuing work. I also thank more than 8,000 members of the public, health professionals and representatives of more than 250 stakeholder organisations who supported the Future Forum and the listening exercise and attended some 250 events across the country. That forum and those people represented the views of the professionals who will implement and deliver the changes, and we accepted all their core recommendations. We brought the Bill back to Committee—the first such Bill since 2003—and we have continued to listen and respond positively. The Bill is better and stronger as a result.

[Mr Cash]

Will my right hon. Friend give way?