Accountability and Transparency in the NHS

Debate between William Cash and Phillip Lee

Thursday 14th March 2013 Commons Chamber

[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—

--- Later in debate ---

[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.