I beg to move,
I understand that the Secretary of State is with the World Health Organisation in Geneva. He spoke to me last week about that. We entirely accept that that is the proper thing for him to do, so I welcome the Minister of State, Mr. Bradshaw to move the amendment and speak on behalf of the Government.
This morning I visited Stafford again, the fourth time that I have done so in two months. I wanted to make sure that I had had an opportunity to talk with those who have been most closely concerned with the failings in care identified at Stafford general hospital, and with efforts to ensure that lessons have been learned. I wanted to discuss with them their view of the reviews published at the end of April by Professor Sir George Alberti and Dr. David Colin-Thomé on behalf of the Department of Health.
The conclusion reached by those to whom I spoke, by us and by many Members across the House who know most about these issues is that those reports to the Department of Health were not independent, were not sufficient, and did not go beyond a superficial examination, in Dr. Colin-Thomé's case, of the role of external agencies. In Professor Sir George Alberti's case, the report was no more than a snapshot of what is happening in relation to Stafford general hospital.
In sum, the reports do not go beyond the Healthcare Commission investigation and report to set out clearly, for the benefit of the public in Staffordshire and south Staffordshire, not only what happened, but why it happened and why the organisations and the senior executives in the health service who were charged with managing the trust's performance, with monitoring and performance-managing the trust at a senior level, and with its performance assessment failed in their task of ensuring that the lamentable failings in the standards of care at the trust were identified earlier and stopped.
Although I very much agree with what the hon. Gentleman has said so far, he said that the people of Staffordshire would be concerned about the matter. Is he aware, as my constituent Trudy Hill has pointed out, that the gravitas of it is exacerbated by the fact that it was of national importance? Many of my constituents from Montgomeryshire also depended on the services of Staffordshire, especially the specialist services. I imagine that the large turnout for the debate reflects both the hon. Gentleman's concerns and those of people in a radius of well over 100 miles of the trust.
I understand the hon. Gentleman's point. Forgive me, Mr. Deputy Speaker, because I should have referred not only to south Staffordshire, because, of course, the issue goes further. Indeed, the issues under discussion range widely: many people, wherever they live, were shocked by what they read in the Healthcare Commission's report and wanted to know not just what happened but why it happened; and people in the hospital knew what was happening but were not listened to when they tried to do something about it, or they did not have an opportunity to do so.
If I may, let me just make this point. The Government promised an oral statement on the two reviews that were published on
Does my hon. Friend accept that people in Staffordshire who have been personally affected by the matter ask for an inquiry, which needs to be independent, not to apportion blame, but to ensure that something like this can never happen again—not just in Staffordshire hospitals but in other hospitals? Rightly or wrongly, they believe that if the inquiry is not independent, it will be a whitewash.
I understand exactly what my hon. Friend says, and he knows the matter very well through his constituency and his constituents who visit Staffordshire general hospital and those who, no doubt, work there. His point is right, because Peter Carter, general secretary of the Royal College of Nursing, visited Staffordshire general a few weeks ago and met nurses from throughout the hospital. He told me that the RCN itself now wants a public inquiry. Although it represents the largest group of staff employed at the hospital, it does not consider a public inquiry being for one minute a distraction or diversion from the delivery of the best quality of care in that hospital. From its point of view, finding out not only what happened but why, and learning those lessons for the future at Staffordshire general and in the wider NHS community, is absolutely vital. The RCN was quite right to make that point.
My hon. Friend knows, because I have told him, that my mother died at Staffordshire general hospital just over 15 years ago. She received fantastic treatment and care at the hospital, and, importantly, many people who have worked there for a very long time and dedicated their lives to giving public service to the health service are, whether we like it or not, blighted by that period. For their sake as well as the sakes of the people who rightly feel most aggrieved, a public inquiry must take place.
I am very grateful to my right hon. Friend, who is absolutely right. I hope that he and Members from all parts of the House will understand that I bow to no one in my support for national health service staff, for what they do and for how they do it. However, they, like anyone, know that the performance and failings of organisations are often systemic rather than personal. We therefore want not only to identify personal responsibility on the part of senior executives, a point to which I shall return, but to understand the systemic problems that meant that good staff, trying to do their best, found that they were unable to do so, because of either staffing and financial decisions, or a lack of performance management and scrutiny by other organisations.
My right hon. Friend makes an important point. One clear example of what the published reviews lack is that Dr. Colin-Thomé, in his report, addressed three recommendations to the Department of Health, as though the Department has serious responsibilities to ensure that the system must change, but no part of it to whether the Department, in the past, took its responsibilities seriously and discharged them. It is as if the Department did not exist before now—that, somehow, it is the solution for the future but did nothing in the past. The Department, however, did a great deal in the past that may have contributed directly to the matter.
I shall of course give way in a second, but let me clarify what I mean. For example, it is abundantly clear that strategic health authorities and primary care trusts, whatever their failings, were significantly damaged by NHS reorganisations and the utter chaos that flowed from them. The Department and the previous Secretary of State were directly responsible for sending the foundation trust's application to Monitor, but, in Dr. Colin-Thomé's report, there was no evidence of the scrutiny that should have been applied, or any reason why it was not. The appointment to SHAs and PCTs of senior staff, and their performance, is a responsibility of the Department, but that was not discharged. Indeed, I shall come on to the central issue of targets and the responsibility of the Department.
My hon. Friend quite rightly refers to the past and its connection with the present. He will also be aware that the current NHS chief executive is David Nicholson, who, at the critical time, was chief executive of Shropshire and Staffordshire strategic health authority and West Midlands South strategic health authority, and that there is a direct connection between those two matters.
I am grateful to my hon. Friend, who understands these matters extremely well. He is right about that, but let me anticipate what I was in any case going to say. Dr. Colin-Thomé points out how the SHA and the PCT failed to meet their responsibilities, saying that the
"PCTs past and present and SHAs past and present do not appear to have taken notice of signs that were present in the survey data and in complaints that indicated poor patient care.
Evidence of poor care has emerged that was not collated or challenged by the PCTs or SHAs at the time."
We know from the Healthcare Commission's report that clinical governance issues that were raised in 2002, and on which its predecessor organisations commented adversely, were exactly the same in 2008. Up until the trust became a foundation trust, the SHAs were responsible for the scrutiny of its performance, and they, in particular, clearly failed to address themselves to the quality of care that the trust provided—to the point at which, in March 2008, when the SHA board received the university of Birmingham's report on data, it said that
"there appeared to be nothing to indicate that anything out of the ordinary was taking place on mortality."
There was a woeful failure on the part of the SHA and the PCT. Notwithstanding the fact that Dr. Colin-Thomé makes it clear that there was such a failure, there is no indication in his review of who was responsible. On the issue of who was responsible, we are talking about David Nicholson, for about a year, who is now chief executive of the NHS, and Cynthia Bowers, subsequently, who is now chief executive of the Care Quality Commission. Standing at the Dispatch Box, I do not know whether I can say that they were directly—personally—responsible for those failings in a way that should be substantively criticised; I do know, however, that the motion is not about criticising any individual, but about establishing a public inquiry. However, I do not want anyone to think that, by calling for an inquiry, we have neglected the fact that the proper purpose of such a public inquiry is to find out whether two of the most senior people in the NHS, with responsibility for its services, have shown that they are credible or capable of such responsibility.
Yes. I look forward to hearing from my hon. Friend if he manages to catch your eye, Mr. Deputy Speaker.
I know that other colleagues across the House want to contribute, so I shall try to be quick. I want to illustrate further why I feel that the reviews thus far have not answered the questions that must be answered. In his report, Dr. Colin-Thomé says:
"I feel very strongly that a lack of good patient engagement is the key to why Mid Staffordshire hospital trust continued to provide poor care for a protracted period of time."
That may well be true, but is there any analysis that goes beyond that? Is there any analysis of how the Government, through the abolition of community health councils and the emasculation of patients' forums, led to a reduction of patient engagement in a way that was a tragic failure? Is there any examination of how foundation trusts are engaging or failing to engage with the public?
The many of us who represent foundation trusts believed that they should be a mechanism for engaging the public, as members of the trusts, more effectively. Clearly, that mechanism failed in this case, but Dr. Colin-Thomé gives us no sense of that. Frankly, all we have from him is what seems to be no more than a bland expression of hope that local involvement networks, or LINks, which were set up by the Department under recent legislation, will somehow be better at all this—without independent powers to investigate, follow up complaints or act as an advocate. In his report Dr. Colin-Thomé seems to think that LINks will be useful, but he did not meet LINks representatives in Stafford, so it is all pure pie in the sky.
Will my hon. Friend make it clear that the investigation would be of considerable importance to the whole country? In my constituency, we face the imposition of a new system that will rip proper, emergency heart care from Ipswich hospital without there having been any discussion whatever. My constituents are left having to go from Leiston to Papworth if they are to have emergency treatment. Such a situation arises if there is no discussion with patients and no concern for them. We need the investigation not just for Staffordshire, but for the whole country.
I am grateful to my right hon. Friend. As he knows, I have visited Ipswich hospital to discuss the removal of its maxillofacial treatment services. I am aware of what my right hon. Friend has described. If he and other colleagues permit me, I will make it my business to visit Ipswich hospital to discuss the issue with its representatives. The services that patients would receive at Papworth hospital would be among the finest anywhere in the world, as it is in my constituency. However, that is not to say that we do not believe that such services should be provided in more accessible locations if they can be and if they are of good quality.
Does the hon. Gentleman share my concern at the apparent drift towards more secrecy for board meetings at foundation trusts? More and more foundation trusts are routinely excluding the public and hospital governors. That is a trend in the wrong direction; there should be more openness and more accountability.
I do share that concern. In that context, I should like to make another important point on which a public inquiry would further add to our knowledge. Just before the Healthcare Commission report was published, Martin Yeates, then chief executive of Mid Staffordshire NHS Foundation Trust, "stepped down"—that, apparently is a term of art. After the commission's report was published, the board took the view that he should be suspended. It instituted an investigation by Peter Garland, a senior former NHS chief executive. Apparently, Mr. Garland has reported to the trust board and told its members the extent to which he believes Mr. Yeates met or did not meet his duties to the board and the trust. That report, however, has not been published and, as I understand it, the trust board does not intend to publish it.
Yet on Friday afternoon—we all know what happens to Friday afternoon press releases—the board announced that Mr. Martin Yeates had tendered his resignation, which the board had accepted. As a consequence, Mr. Yeates will receive his notice period; in addition to his two months' pay on gardening leave, he will get six months' pay. He has effectively been put beyond the scope of disciplinary action, unless a breach of duty can be demonstrated. Clearly, that will not happen unless all the evidence is brought out in a public inquiry. I am not accusing Mr. Yeates of anything, but we are not being given access to any of the information on which a judgment can be based.
I turn to another important point, to which Dr. Colin-Thomé referred. It is about complaints. Again, Dr. Colin-Thomé did not put forward any suggestion about what should be done. All he said was that the Government's reform of the complaints system in recent legislation will somehow make things better. There is no evidence to suggest that. On the contrary, there is the idea that the new Care Quality Commission will not have a responsibility in the scrutiny of second-stage complaints; that will disappear off to the ombudsman. That undermines further, as compared with the past, the ability of Care Quality Commission performance assessment to be combined with intimate knowledge of what is happening inside a trust.
Frankly, there are already questions about the extent to which the Healthcare Commission acted; second-stage complaints should have been getting to it, but they were not. Where were the complaints going? That is the interesting question. The Healthcare Commission report says that some of them were going to strategic health authorities, others to the National Patient Safety Agency and some to the Healthcare Commission itself—there was no rhyme or reason about it. The system in relation to the complaints is dysfunctional, and the Healthcare Commission, which most needed to know—its statutory responsibility is to investigate when patients' quality of care is being compromised—did not know. If it did, we need to understand to what extent it was acting on the complaints.
Individual complaints were investigated by the commission; one has come to me. The commission concluded that there had been gross professional negligence and demanded that Staffordshire hospital prepare an action plan in response within five weeks. That happened in October 2008, but did the commission get such a response? Not at all—there was no response. Even as recently as the early part of this year, Mid Staffordshire NHS Foundation Trust was failing to respond to serious conclusions drawn by the Healthcare Commission. That is another reason why it seems to us that the Healthcare Commission was not by any means the last word.
I said that I would also refer to targets. When the Healthcare Commission's report was published, the Minister said that the issue had nothing to do with targets. Will he accept that, as Dr. Colin-Thomé makes clear in his report:
"A key lesson is that all organisations should be focused on prioritising high quality patient care as judged by outcomes, and whilst process targets are very helpful on the journey, they must not become a distraction from the bigger picture"?
What have we been doing for the past two years? We have been talking endlessly about the importance of focusing on outcomes rather than targets. What have Ministers been doing? They have been talking about the desirability of using targets as the be-all and end-all. Even now, as the new Health Bill is discussed in another place, there is a view that emergency services are measured sufficiently by simple reference to whether the four-hour A and E target is adhered to or not. That ignores the enormous spike when people are discharged from accident and emergency departments after three hours and 59 minutes. Furthermore, the Healthcare Commission report makes it clear that patients were being discharged elsewhere rather than getting the treatment that they needed at the time they needed it in the emergency department.
One of the questions that must be resolved is why staff in the hospital who raised these matters did not get anything done about it, and why others did not blow the whistle when they should have done. I find no evidence in what Dr. Colin-Thomé has reported, or in what Sir George Alberti has written, to explain that. Dr. Colin-Thomé simply says that it happened—he does not know why. As I am sure that my hon. Friend Mr. Cash will agree, the starting point in finding out what really happened, and why, is to ensure that people at the trust—some of whom, until very recently, felt too intimidated to speak out—feel that they have the protection of giving evidence to a public inquiry under oath, with all the statutory powers that go with that. We have proposals for improving whistleblowing. The Government should have the humility to recognise that nobody contacted Public Concern at Work and nothing was done to bring forward into the public domain the concerns that were clearly held by staff at the trust.
The hon. Gentleman raises concerns about a bullying culture. There is also the issue of the duty, or responsibility, of the clinicians themselves. It appears that some clinicians ultimately failed to meet that duty by reporting the serious concerns that they must have had. Does not that also need to be addressed, because someone needs to be held to account in terms of clinical behaviour?
Yes, it does. It may be excessive to expect that even a public inquiry would be able to identify, in all cases, where and to what extent that had happened. However, if a review of case notes gives rise to serious concerns about a significant number of cases, at least a public inquiry would provide a mechanism in the round to consider what that tells us about the clinical governance that was being undertaken and how it may need to be reformed in future.
I want to make a specific point about what has not been achieved by these reviews. For several years, the Government have had the National Patient Safety Agency. One of its principal tasks involves the national reporting and learning system, which should in itself give rise to alerts about the compromise of patient care and errors and inefficiencies. I have failed to see any evidence anywhere in the reviews that the National Patient Safety Agency exists, let alone that it has done anything. If a public inquiry were to look into failings of policy, and needs for the future, that would clearly be one of them.
I hope that, in the course of the past few minutes, I have made it clear that the questions about why Stafford hospital failed its patients in emergency services and admissions, as identified in the Healthcare Commission report, have not been answered, and why a public inquiry is therefore needed. The reports thus far have not given the public in Staffordshire a voice, and they have not provided a public opportunity, with protection, for evidence to be taken. The reports were not independent, and they have failed to investigate the direct role of the Department of Health and its policies. Until recently, both the authors were civil servants in the Department of Health: they are not independent, and we should not see them as such. Neither report contained critical scrutiny of the impact of targets. There was no critical examination of the role of the chief executives of the strategic health authorities over the period in question. There was no discussion of the roles of the national reporting and learning system or of the National Patient Safety Agency. There was no discussion of how the complaints processes have worked or how patient engagement has worked, and no substantive proposals about how they can be reformed in future, as they clearly must be. Instead of robust criticism, all we have is a bureaucratic process. Dr. Colin-Thomé's report, in particular, suggests that the things that the Government were already planning to do, such as practice-based commissioning, world-class commissioning and LINks, will somehow solve everything. There is no evidence that that will happen—far from it. Indeed, some initiatives, such as practice-based commissioning and LINks, are stalling rather than making the progress that they should.
Because of all that, the reports do not shed light on why those in the hospital and elsewhere failed to stop the tragic events that have killed, or caused avoidable deaths among perhaps hundreds of patients, with all the distress that that has meant for their families. I again pay tribute to Julie Bailey and all her colleagues at the Cure the NHS campaign, who persisted when the situation was very difficult and it took courage to do so in the face of a bureaucracy that was determined that they would not expose what was happening at Stafford hospital. They want an inquiry now, and say that only when we know why and how this happened will the commitment to say "Never again" truly be credible. Ministers have been to see them and have promised to think again, but I do not see the evidence that they have done so. It is therefore incumbent on Parliament to require them to think again, and I commend the motion to the House.
I beg to move an amendment, to leave out from "House" to the end of the Question and add:
"notes the independent report by the Healthcare Commission which identified severe failings at the Mid Staffordshire NHS Foundation Trust and the follow-up reports by the National Clinical Director for Emergency Care and the National Clinical Director for Primary Care which state that Stafford Hospital's accident and emergency department is now safe but that further improvements must be made at the Trust and lessons learnt by the whole NHS;
further notes that the hospital has offered independent reviews of clinical records to all concerned;
agrees that at the present time it would not be appropriate to establish an independent public inquiry;
further agrees that management and staff at the hospital must remain focused on delivering high quality patient care;
and further agrees that an independent public inquiry could add undue delay to implementing the recommendations of the above reports and therefore to the hospital delivering high quality and safe services for the local community ."
I am grateful for the shadow Health Secretary's understanding of the fact that my right hon. Friend the Secretary of State cannot be with us this evening because of the assembly of the World Health Organisation.
The Government immediately announced a range of measures, including two swift reviews of the circumstances at Stafford hospital, to be led by Professor Sir George Alberti, the national clinical director for emergency care, and Dr. David Colin-Thomé, the national clinical director for primary care. Professor Alberti looked into the hospital's current procedures for emergency admissions and treatment, and its progress against the recommendations in the Healthcare Commission's report, while Dr. Colin-Thomé looked into the circumstances surrounding the Mid Staffordshire NHS Foundation Trust prior to the Healthcare Commission's investigation to learn lessons about how the primary care trust and strategic health authority, within the commissioning and performance management systems that they operated, had failed to expose what was happening at the hospital. Copies of those reports were placed in the Library on
I heard what the hon. Gentleman said about the lack of an oral statement. He will know that providing an oral statement is not in the gift of an individual Secretary of State. The Secretary of State has gone out of his way to keep the House informed, but it is up to the business managers. The hon. Gentleman may also recall that on that day Members were discussing MPs' expenses at some length. I personally would have very much welcomed the opportunity for an oral statement to be made, but it was not agreed to by the business managers.
The Minister knows very well that I had a personal conversation with the Secretary of State where he clearly understood that an oral statement was to be given. Furthermore, just before business questions a week last Thursday, I received a letter from the Leader of the House saying, in effect, that she apologised for the fact that an oral statement had not been given because the matter had already been dealt with by a ministerial written statement. The Minister is being disingenuous, to put it mildly.
The facts as the hon. Gentleman states them are not correct. The Secretary of State wanted to deliver an oral statement, as he made absolutely clear when he made the original oral statement. The hon. Gentleman has been long enough in this House to know that oral statements are not in the gift of an individual Secretary of State.
I will not give way again now. I will do so later to the hon. Gentleman, who has had much opportunity to raise the issue in the House, of which he has not always taken advantage.
I would like to move on to the big issue of an inquiry. I want to discuss some elements of the amendment, which states that there should not be an inquiry at this time. Is my hon. Friend willing to start talking to those with an interest—me, other Staffordshire Members of Parliament, Opposition parties—about the form and terms of reference of an inquiry in the near future?
As my hon. Friend knows from the many discussions that the Secretary of State and I have held with him, we are always open and willing to discuss any ideas that he has, but I shall address the specific matter of a public inquiry at some length later.
The Government accepted all the recommendations of both reports and have begun to implement them in full. In summary, the reports found that, first, significant improvements had already been made at Stafford hospital. Services in accident and emergency were now safe, but there was an urgent need to make further improvements to other services and to rebuild local confidence in the trust. Secondly, in the past, patients' views were not taken seriously enough and were too easily dismissed. Thirdly, there was a lamentable failure of clinical leadership in the trust and the wider health community. Fourthly, the commissioners of local health services were not sufficiently aware of the poor-quality care in the hospital or active in addressing it. Fifthly, all parts of the system should have worked together better in the interests of patients.
Some have attempted to suggest that what happened at Stafford hospital is typical of the NHS as a whole, or was a result of targets or some other national policy. It is important to recognise, not least because of the fantastic job that NHS staff do in hospitals throughout the country, that the Healthcare Commission and the two subsequent reports found that what happened at Stafford hospital was the result of catastrophic local failure. Every NHS nurse, doctor and manager in the country to whom I have spoken is as horrified by events there as we all are.
The onus must, therefore, be first and foremost on Mid Staffordshire NHS Foundation Trust, together with its local partners and South Staffordshire primary care trust, to address the recommendations relevant to them in the reports, make further improvements in the quality of care and rebuild local confidence.
Does the Minister have confidence in the procedure that Monitor adopted to secure foundation status for Stafford hospital? What worried me when Bill Moyes appeared before the Health Committee was that he talked about looking at press reports in future to get intelligence about hospitals. I would have hoped that the investigation would be much more robust. I am concerned about what that means for the process that University hospital of North Staffordshire may undergo soon. It, too, wants foundation status.
As my hon. Friend knows, Monitor has changed and made more robust its process for assessing candidates for foundation trust status. Even at the time, it considered quality of care. As she knows, the Healthcare Commission's announcement of a formal investigation came after foundation trust status had been granted to Stafford hospital. However, I will raise her concerns with Bill Moyes on her behalf, and I trust that she will do so about University hospital of North Staffordshire.
We all understand the need for the relatives of patients who died at Stafford hospital to know whether there is any suggestion that death was attributable to the poor care described in the Healthcare Commission's report. The primary care trust has a widely publicised confidential helpline, on which concerned relatives can request a thorough and independent review of the clinical records of the patient in question.
The coroner in South Staffordshire, who was also mentioned in the Healthcare Commission report, has said that he will consider any requests for an inquest from the relatives of patients who died at Stafford hospital.
It is encouraging to hear about the coroner's change of heart, but is not a change to legislation required to ensure that, in future, there is no refusal to co-operate with an inquiry, as happened in this case?
The coroner disputes that allegation—I simply point that out to the hon. Gentleman. The coroner does not accept that version of events. The hon. Gentleman knows that a measure is currently being considered in Parliament, which addresses some of the issues that he raises.
The reports of both Dr. David Colin-Thomé and the Healthcare Commission were highly critical of the closed culture that operated at Stafford hospital. All NHS organisations must ensure that they operate in accordance with the current guidance, which promotes openness, transparency and accountability to their local populations. That includes boards holding meetings in public. The new board of the hospital now holds its quarterly meetings in public.
It is clear from the reports that complaints were not tackled satisfactorily at Mid Staffordshire NHS Foundation Trust. The high number of upheld complaints was one of the things that first worried the Healthcare Commission. As of
We are discussing with the health ombudsman publishing the number of complaints from each trust referred to and upheld by her. All that information will be placed on the NHS Choices website, allowing easier comparisons between hospitals.
I welcome my hon. Friend's comments about examining local improvements that need to be made. I have read the two reports and I welcome the fact that, in three months, the PCT, Monitor and the Healthcare Commission will examine the way in which local services have improved. Does he share my concern that, although that covers examining local improvements, in the fullness of time we need a full inquiry to consider systemic problems on a national basis so that we can all learn from a tragic incident that involves many people? We need to ensure that we learn from that, not only in one local area but throughout the country.
I have sympathy with my hon. Friend's comments about the importance of going back and ensuring that Stafford hospital has acted on the recommendations of the Healthcare Commission report and the other two reports. However, she knows that the independent regulator's report and the others stated that they were satisfied that the problems in Stafford hospital were not systemic in the NHS as a whole. To claim that would be a great mistake and do a great disservice to NHS staff throughout the country—the vast majority of hospitals manage to hit the A and E four-hour waiting target and deliver high-quality and safe care to their patients every day. We have ascertained the lessons to be learned for the rest of the service from the Healthcare Commission report and the other reports, and they are already being implemented. However, I do not believe that the Opposition and some other hon. Members are calling for an inquiry into that. They want an inquiry into the specific circumstances at Stafford hospital and I shall shortly cover why that would not necessarily be sensible at this stage.
Will the Minister help me and explain to my constituents how we can believe in the new attitude to complaints when my people have been told that the minimum time for a journey from their home to emergency heart operations is 160 minutes? My constituents complained before the changes were made, yet it has been announced that there is no need for public consultation on the changes. The Minister must accept that we need a report on the subject that we are considering to raise the bigger problem throughout the country that complaints are not being heeded—either after changes are made or before they are implemented. Strategic health authorities currently issue a diktat. He must understand that complaints must be listened to.
Order. The interventions are getting a little long and we have a limited time for hon. Members who wish to speak on the subject from the Back Benches.
I shall take your advice, Mr. Deputy Speaker, and be a little more conservative in my tolerance of interventions.
Mr. Gummer confuses complaints about individual poor care with service changes. I think that he referred to a proposed service change by his local hospital or PCT. I am sure that he knows that there is a robust and formal consultation process for such a change. One of the most effective things he can do is persuade his local—probably Conservative—councillors, who dominate the overview and scrutiny committee in his area—
Is not Suffolk county council a Conservative authority? The councillors can raise concerns and refer a major service change, with which the right hon. Gentleman is unhappy, to an independent national panel.
Another thing that alerted the Healthcare Commission to potential problems at Stafford hospital was its very poor performance in the annual NHS staff survey. The question of whether staff would be happy to be treated in the hospital where they worked was dropped by the Healthcare Commission in 2007 because of concerns that its wording could lead to distorted results for some providers.
The hon. Gentleman, again from a sedentary position, says, "Rubbish." The Healthcare Commission—the independent regulator—made that decision because of the danger that if, for example, those working in a psychiatric hospital were asked whether they would like to be treated in their hospital, a lot would obviously say no. We have agreed with the Care Quality Commission to reintroduce the question asking staff how they rate the quality of care in their hospitals, albeit avoiding the problematic wording of the question contained in the earlier survey.
The hon. Gentleman said the decision was taken by the independent health regulator, but will he confirm that the decision to drop the question—not the decision to reform it—was made in direct consultation with his Department?
No, the survey belongs to the independent regulator. The regulator consulted the Department and, for the reasons that I have explained to the hon. Gentleman, we accepted its concern that the wording could distort the responses of those working in psychiatric hospitals, in mental health and so on.
The hon. Gentleman also talked about whistleblowing. Although the board at Mid Staffordshire did not listen to the concerns of patients or staff, we share his surprise that more professionals in the trust did not put their concerns on the record. The NHS exists to meet the needs of patients. Individual members of staff have a right—indeed, a duty—to raise any concerns that they may have about the quality of patient care with their employer. It is important to remind all staff who work in the NHS and their managers that whistleblowers have full protection under the Public Interest Disclosure Act 1998. Furthermore, the new NHS constitution includes an explicit right for staff who report wrongdoing to be protected.
Let me deal with the central issue of the Opposition motion, which is the call for a public inquiry. Public inquiries can be an important mechanism to establish independently the cause of a problem or disaster. I can understand that there are many who consider that a public inquiry into the events at Mid Staffordshire is both appropriate and necessary. A number of people have recalled the Bristol heart babies inquiry. In our view the critical difference is that that inquiry was initiated when, under the previous Conservative Government, there was no independent watchdog or regulator for the NHS.
The whole point of establishing the Commission for Health Improvement in 2000 and the subsequent regulators since was to provide the public with the confidence that any concerns that they might have about NHS care in their areas would be properly and independently investigated. I have not heard any criticism of the Healthcare Commission's investigation or any suggestions that it did not get to the bottom of what went wrong at Stafford hospital. Given that, as well as the two subsequent inquiries and the action flowing from them, the Government remain unconvinced at this time that a public inquiry would add anything to our understanding of what went wrong or of what needs to be done to prevent such terrible events from happening again.
I will give way in a second. I have been very generous in giving way; the hon. Gentleman does not need to nag me to give way.
I would also remind hon. Members that public inquiries take a long time. The Bristol inquiry took three years and the Shipman inquiry took five. We have concerns that, as well as not adding to the sum of our knowledge of what happened at Stafford hospital, a public inquiry could distract the new management and the staff at the hospital from focusing on further improving the quality of care for local people.
I am grateful to the Minister for giving way and apologise for nagging him. The Government's amendment says that an inquiry would not be appropriate "at the present time". Earlier in his speech he said that an inquiry would not be appropriate "at this stage". He seems to be leaving the door open. Is that the case and will he consider further representations about the possibility of establishing a public inquiry?
As I hope the Secretary of State and I have made clear, we are always open to representations. We have listened carefully to those that have already been made, by both hon. Members from all parts of the House and Julie Bailey, to whom I join the Opposition spokesman in paying tribute. However, so far we remain unconvinced, and that is as far as I can go.
In a letter to my hon. Friend Dr. Wright from Sir Ian Kennedy, the outgoing chairman of the Healthcare Commission who chaired the Bristol babies inquiry, Sir Ian said that he did not think that a public inquiry would be justified in this case. However, as we have repeatedly made clear to hon. Members and to the local patients organisations and others, if there are significant issues or lines of inquiry that they do not think have been addressed, either by the Healthcare Commission report or by the subsequent reviews, the Secretary of State will be only too happy to consider them.
Is the Minister aware of the fact that, before he became the chairman of the Healthcare Commission, on the Bristol inquiry, Sir Ian Kennedy said that the importance of a public inquiry is that it offers an opportunity for people to be heard and to listen to others? He also said that a public inquiry
"allows for the public venting of anger, distress and frustration; it provides a public stage on which this can take place."
Sir Ian Kennedy thoroughly endorsed the idea of a public inquiry. If Bristol, why not Stafford?
For once I am grateful for the hon. Gentleman's intervention, because it makes my case exactly for me. If someone such as Sir Ian Kennedy, who said that about the importance of public inquiries, does not believe that a public inquiry is necessary or desirable in this case, that absolutely makes the point for me. I am grateful to the hon. Gentleman.
Martin Yeates, the former chief executive at the foundation trust, stepped down from his post on
However, given the grave events at Stafford hospital and the understandable level of public concern, I find it hard to understand why the decision was made not to go through a disciplinary process. The Secretary of State has accordingly written to Monitor today, asking to see a copy of the investigation into Mr. Yeates. If we still have concerns after we have seen that report and heard the explanation, we will consider what further action needs to be taken. The Secretary of State could not have made it clearer that there can be no rewards for failure in the NHS.
We did that in the case of Rose Gibb, the former chief executive of Maidstone and Tunbridge Wells hospital, and we won. We expect the whole of the NHS to understand that the public will not tolerate cosy deals when they have suffered from such abject management failure.
Would the Minister undertake to publish that report, so that everyone can see what it says about the governance of that hospital?
I am sure that the Secretary of State will want to consider that question, but given that he commissioned that work—just as he did all the other reports, all of which have been put in the public domain—I should be very surprised if he did not agree. However, we need to see the report first.
The Healthcare Commission's report laid bare appalling failure at Mid Staffordshire. The two subsequent reports made further and far-reaching recommendations, which are being implemented locally and nationally, in order to ensure that every hon. Member will be satisfied that such terrible failure can never be allowed to happen again.
I welcome this debate and I am pleased that it has been called. I join the Minister and the Conservative spokesman in paying tribute to the work of Julie Bailey who, together with others, has been persistent in refusing to be fobbed off in the pursuit of complaints. They are to be applauded for their persistence.
I apologise; the hon. Gentleman beat me to it.
Ever since then, I have maintained my view that a public inquiry must be set up. There are Labour Members who feel the same way, and it is important that we all maintain the pressure on the Government to accept our pleas. It was interesting to hear the Minister's response regarding the wording of the Government's amendment. The words that he used in his speech seemed to suggest that there was a chink of light there. It seemed to me that the Government might just be open to persuasion.
I am pleased that the hon. Gentleman thinks the Government might be open to persuasion, but what I heard from the Minister—I hope he will correct me if I misheard him—was that the Government were always willing to entertain representations. That is fine, but he also said that a public inquiry would be a distraction to the management. To me, that certainly does not suggest a chink of light; it merely suggests that the Government will listen but take no action.
I understand that concern, and all hon. Members on both sides of the House who feel strongly about this should combine to put the maximum pressure on the Government, not only in tonight's vote but subsequently, to ensure that the issue does not just go away. There is always a danger, as events move on, that these issues can slip down the agenda, but we must not let that happen in this case.
I am sure that that is the case. I agree that it should be impossible for the Government to ignore that evidence.
To date, the Government's response has been to scapegoat the local leadership. The local leadership absolutely has to take responsibility for what happened, but the Government's strategy appears to be to apologise on its behalf and to move on. That will not do. It is right that those in a position of leadership at the hospital should be held to account, but that strategy fails to recognise that wider lessons need to be learned from this awful horror. The former chairman of the Healthcare Commission described the events as the worst care ever witnessed in the NHS. That in itself is a pretty compelling reason for a public inquiry in this case. Those wider lessons seem to have been brushed aside by the Government, reflecting their stubborn resistance to recognising that, for example, the four-hour target played any part in what happened.
I want to run through some of the key reasons for holding a public inquiry. They relate to the specific situation at the hospital and to the wider issues involved. The first involves the position of Mr. Yeates. The Minister said that he was concerned because the board had allowed Mr. Yeates to resign without going through a disciplinary process. I am pleased that the Minister said he expected the report into these events to be published. He said that the Government would need to see it first, but it should be placed in the public domain irrespective of what it says. It was commissioned by the Secretary of State to look into what led to this awful disaster, and to examine Mr. Yeates' role in it, and that information should be put into the public domain straight away.
Is the hon. Gentleman perplexed, as I am, about why, if the Secretary of State commissioned Peter Garland to undertake this work, Peter Garland did not report to the Secretary of State? If the foundation trust has the degree of independence that I think it does, and it has now made its decision, the Secretary of State must surely be powerless to do anything about it now.
I think so.
In regard to the resignation, it is now too late to institute disciplinary proceedings. We have been presented with a fait accompli, and the former chief executive is now being paid to be on gardening leave for the rest of his notice period. The NHS is paying for that, despite the fact that there appears to be good evidence to justify a disciplinary inquiry. I also agree with the hon. Gentleman that the report should have gone to the Secretary of State, given that it was commissioned by him.
I hesitate to intervene on the hon. Gentleman again, because he is an employment lawyer by profession. Mr. Yeates might not necessarily be beyond disciplinary action, but would there not need to be substantive evidence of a breach of his fiduciary duties to the board in order for such penalties to be contemplated? A public inquiry might be a principal mechanism by which such evidence could be gathered.
I agree with the hon. Gentleman entirely. That is one of my reasons for arguing that a public inquiry should take place.
It might be helpful to both hon. Members if I clarify who commissioned the report. As a foundation trust was involved, the report was of course commissioned by the trust itself, but that decision came out of the overall response to the Healthcare Commission inquiry by the Secretary of State, in conjunction with Monitor. So in legal terms, it is absolutely right that the report should go back to the trust, but that does not take away from the points that I made earlier about what needs to happen now.
I am grateful to the Minister for that clarification.
The second reason why there should be a public inquiry is the role of the clinicians in the hospital. Many people have expressed their concern that, despite the awful things going on there—the dreadful care to which the former chair of the Healthcare Commission referred—it appears that no clinician saw fit to report their concerns to senior management or elsewhere, with the possible exception of one nurse, about whom we heard last weekend. It could be argued that they felt prevented from doing so by the bullying culture in the organisation. However, they have a professional clinical duty to their patients, and, irrespective of the extent to which the unit was understaffed, if they saw that there was inadequate care, it was their duty to report their concerns and to get something done about it. That did not happen, and that in itself is a scandal that should be investigated by way of a public inquiry. It is not being looked at in any other way. None of the reports that the Secretary of State has commissioned has looked at that issue. As things stand, those clinicians who participated in the care that has been so heavily criticised are presumably continuing to work in the NHS. Should we not be concerned about that? That issue is not being addressed, and it ought to be.
The other issue relating to clinicians is the culture of bullying that appears to exist. The Sunday Telegraph this weekend reported concerns raised by a nurse who had previously worked in the A and E department at the hospital. She raised those concerns in November 2007, yet nothing appears to have been done. She referred to "racist abuse", and to the fact that nurses were
"routinely ordered to lie about how long patients had been waiting".
She also reported:
"Junior doctors were bullied into discharging patients before they had been properly examined in order to meet targets".
The hon. Gentleman might know that many of those allegations were also made during Simon Cox's programme on Radio 4, which many of us have on disc. These questions must be looked into properly because they are so grave, as some of the quotations that I shall give the House from the statement by that nurse will amplify.
I agree. I am making the point that this is another reason for the whole issue to be the subject of a public inquiry.
It is easy to say that this culture exists in only one hospital and could not exist in any other, but we hear too many stories of a similar culture existing elsewhere. That is why the wider implication of the management of the NHS and the extent to which clinicians and other hospital staff feel constantly under pressure because of targets imposed from above, and the way those targets are enforced, should be looked into by a public inquiry.
The third reason why there should be a public inquiry is to secure justice for the families that have been so horrendously affected by this awful scandal. So many of them have refused to be fobbed off, but the fundamental question remains about how justice will be secured for families of the victims of this dreadful care. That is another issue that is not being properly addressed in any systematic way other than by this review of patient notes—a review that looks at each case individually, which is not sufficient if we want to see the whole picture and understand how this happened. We need to give those families a real sense that their concerns are being properly addressed.
The fourth issue, which I raised in an intervention on the Minister, is the role of the coroner. The Minister made the point that there appears to be some challenge to the conclusions of the Healthcare Commission report; I understood the Minister to dispute the fact that the inquiry was obstructed in some way. Surely, however, we need to address the fact that there is potential for coroners to obstruct inquiries, so we need clear rules and clear guidelines about coroners' responsibilities to co-operate fully in such circumstances.
When the Minister referred to legislation going through Parliament, I assume he meant the Coroners and Justice Bill. He said that there were measures in it to address some of these concerns, but will he clarify whether any thought is being given to the possibility of tabling an amendment to place a specific statutory duty on coroners to co-operate in inquiries of this sort? I would be happy to allow him to intervene—now or later—to confirm that it will be possible to amend this draft legislation.
The next reason why we need a public inquiry relates to the roles of the PCT and the SHA in the context of what this whole scandal means for commissioning. We hear a lot about the pursuit of world-class commissioning, but in this particular case it is clear that the PCT and the SHA failed abysmally to play an adequate role as commissioners of care at this hospital.
Does this case not show that this health authority tier or level is, frankly, unnecessary? We know that the health service needs to rationalise and save money, so is it not time to abolish a failing tier of the NHS that did not do its job in this case?
I certainly agree with my hon. Friend.
Sir Ian Kennedy, in a letter that followed the publication of this report, said:
"The responsibility for managing performance, including effecting necessary improvements, lay and lies with the trust and its performance manager, the Strategic Health Authority, the commissioning PCT and, after the award of Foundation Trust status, Monitor. These performance managers"— it seems to me that there are too many of them—
"are able to visit any trust and call for whatever information that they believe is necessary from the Trust to carry out their duties."
Well, what did they do to carry out those duties? What visits did they undertake, or was it simply a paper exercise, considering those excessive death rates from afar? That is a central question.
Sir Ian went on to say in the letter:
"Following normal practice, efforts were made" by the Healthcare Commission as part of its investigation
"to liaise with the trust and the SHA to explore what was needed".
So what co-operation did it receive? Was the response adequate, particularly that of the SHA? Sir Ian continued:
"The investigation team at the Commission did not know that the Trust was being considered for this status"— that is, foundation status, which seems quite extraordinary—
"and was not asked whether there were concerns about the performance of the Trust in terms of the safety and quality of care... We understand that Monitor asked the Strategic Health Authority for its views; the SHA was aware of our work on mortality outliers and 'alerts' by then", yet it did not say anything—again, quite extraordinary.
That, of course, raises questions about the chief executive of the SHA, who was Cynthia Bower. I should say that she has been to see me and that I had a very helpful meeting with her; she was very candid. It nevertheless seems to me of fundamental importance that because she was the chief executive of the SHA—one of the performance managers of this hospital—there is a conflict of interest so far as any internal investigation is concerned. That is another clear reason why we must have an independent public inquiry.
The next reason is the role of targets, particularly the four-hour target. The Minister steadfastly sticks to the line that it is all down to just this hospital and the outrageous way its management behaved. When visiting hospitals around the country—I am sure other hon. Members will have noticed the same thing on their visits—I have found that one of the things clinicians say in A and E departments, and this is a credit to the Government, is that the four-hour target has transformed how A and E and hospitals operate. I accept that it has been transformational: we all know it was unacceptable for people to be left waiting in corridors on trolleys for 10 or 11 hours. The Minister must recognise that there are nevertheless concerns in hospitals up and down the country about how the target is enforced, particularly when it becomes a straitjacket. If the Minister talks to clinicians, as I know he has done, I am sure he will also be aware of concerns expressed about the operation of this target in many hospitals. The Royal College of Nursing has made it very clear that strict adherence to 98 per cent. compliance with the four-hour target has caused real difficulties.
Is the hon. Gentleman aware that a nearby hospital in Westminster provides an example? The system there is that when people enter a room, there is effectively no system until they eventually get to see a nurse for triage—and it is fairly chaotic at times. When I asked why it was like that, I was told that if people were given a number as at a delicatessen counter in a supermarket, the four-hour clock would have to start. What happens, then, is that the patient dripping with blood fails to get to see the triage nurse; meanwhile, the patient who is relatively fit does get to see that nurse when the four-hour clock starts ticking. That is the sort of distortion that occurs.
"Doctors were moved from treating seriously ill patients to deal with those with more minor ailments, in order to avoid breaching the four-hour waiting time target. Patients were moved to the clinical decision unit to 'stop the clock' but were then not properly monitored, since this area was not staffed."
Michael Fabricant has made that point, but the Minister seems blind to the possibility that such concerns might exist elsewhere and that patient care might have been compromised. That is a fundamental reason why a public inquiry needs to explore that issue.
The Healthcare Commission report also included a graph showing a spike just before the four-hour point, with large numbers of patients being discharged as the clocked ticked away towards it. Surely we need to explore whether the same pattern of discharge applies in other hospitals to see whether the same pressures might be applying elsewhere. The Government seem blind even to considering that possibility and so defensive about the four-hour target that they are not prepared even to consider whether any potentially adverse aspects apply to it. The conclusions of the Colin-Thomé report appear also to contradict the Minister with regard to the role of the four-hour target and how it has been implemented.
The next reason there needs to be an independent inquiry is the implications of the scandal for the regulators. The process that this hospital went through to become a foundation trust without anyone stopping the hospital in its tracks to demand improvements before it happened beggars belief. It is extraordinary that it was signed off by the primary care trust, the strategic health authority, the Department of Health, the Secretary of State himself, as I understand it, and the Monitor board.
Did no one notice what was going on in that hospital, right under their noses? It smacks of an appalling tick-box culture whereby, provided those on the ground have ticked the box to say that something is working properly, everybody accepts it and the hospital gets its star rating. That is exactly the same as the culture that applied in Haringey, which gave the local authority three stars at the time when baby P was dying in tragic circumstances. The way in which hospitals achieve secure foundation trust status must surely be further explored.
Does the hon. Gentleman accept what I said earlier about the paper trail and the minutes going right back from the current chief executive of the NHS and the chief executive of the Care Quality Commission to Shropshire and Staffordshire strategic health authority and the West Midlands strategic health authority? At the critical time when all these things were happening, Ms Hewitt was Secretary of State and 17,000 jobs were being cut out of the health service. This is a continuous paper trail, which can be demonstrated.
That is the sort of evidence that needs to be properly and fully considered by a public inquiry. A few weeks ago, the press reported on the fact that some 22 hospital trusts have been given foundation trust status despite failings, sometimes of a serious nature, in meeting basic health care standards.
A lot of work on Staffordshire hospital has been done by The Sunday Telegraph, which reported:
"At the point the authorisation was made, the trust was missing government targets to reduce MRSA, had long waits in A&E, and for clot-busting treatment for heart attack victims, the documents from Monitor, the regulator, show.
A further 21 trusts were also given" foundation trust status
"despite concerns about the quality of the care they provided."
What happened in those cases? They were issued with side letters by Monitor requiring them to take corrective action to remove those concerns, but they still secured foundation trust status. Was that made public? Were the public ever told in all those cases that there were concerns about patient care quality? That is very much not the message that the Government gave when foundation trusts came into being. That status was supposed to be a symbol of absolute quality—quality assurance.
We must bear it in mind that for the chief executives of hospital trusts there is a big financial incentive. They invariably receive substantial pay increases when their hospital becomes a foundation trust. That needs to be looked at in a full public inquiry.
The Conservative spokesman mentioned the handling of complaints. He said that complaints ended up at a range of different destinations, which is surely completely unacceptable. The public must understand exactly what will happen to their complaint if it is not accepted and upheld at trust level.
There are vital lessons that need to be learned from this awful scandal. It is all very easy simply to place all the blame on the local leadership, but there are clearly lessons that the wider NHS and the Department of Health need to learn. It is surely our duty to all patients in the NHS to ensure that those lessons are learned. For that reason, there must be a public inquiry.
Order. The clock is moving on, and, given the number of Members seeking to catch my eye, I propose to reduce the limit on speeches to 10 minutes as from now.
As a Labour Member of Parliament I am committed to the NHS, and as Stafford's Member of Parliament I am committed to a hospital in Stafford, so it broke my heart to read in the Healthcare Commission's report that patients had been severely, appallingly let down by the NHS and the local hospital.
I support a full, independent public inquiry into every aspect of what went wrong, why, and how it can be put right for the future. I shall vote for an inquiry tonight. Yes, an inquiry will take some time to complete its investigations and deliberations and produce a report, and, yes, it can be distracting for people who have a job to do at the hospital while the investigations are ongoing. However, the work has to be done. One thing we can usefully do is talk about the form and terms of reference of the inquiry. If the Government will not give way on this today, one way in which we can continue the pressure is to start to get ready for an inquiry.
I wish to say a word about my hospital—if I may call it that—and what my public and my patients want today. An inquiry will take some time, but there are things that need urgent attention at Stafford hospital, and I do not want us to lose sight of that urgency because we are also talking about a public inquiry. For example, the Healthcare Commission's report told us about the severe understaffing on wards and the urgent need for more staff. It told us about missing medical equipment and the urgent need for it to be provided. Six weeks later, Professor Alberti produced his report and said that there were staffing shortages and that more staff urgently needed to be appointed. He said that there was an urgent need to provide some medical equipment that was still missing. Six weeks on, the urgency had not been accepted and implemented. We must not overlook the fact that those things are still urgent today.
I remind the House that the Healthcare Commission produced damning evidence about three aspects of the hospital: accident and emergency, emergency care and some nursing care. However, in the same report it mentioned positive things about the hospital. There were no concerns about elective care, and during the three-year period investigated there was a decline in the number of complaints about out-patient care. There was praise for the acute coronary care unit and the critical care unit. It is important to retain a sense of balance. People going into that hospital had good experiences in some parts of it at some times, just as others had bad, sometimes appallingly bad or fatal experiences. I ask the House to bear that in mind.
When Professor Alberti went in after the Healthcare Commission, he was able to talk about improvements in A and E and say that there had been some improvements in emergency care, although not enough. He mapped the way to continuing that improvement. He said that even when he was there, there were still instances of poor nursing care that needed addressing. He made a warts-and-all assessment, which showed that we still need urgent attention given to some things. It is very important to remember that.
Let us imagine the effects of working at that hospital today, given all the bad publicity that has appeared nationally, and the likelihood that people will complain about anything for fear it will not be spotted if a complaint is not made about it. Let us imagine every story that someone chooses to publicise becoming a headline in the local newspaper. Morale is very low at the hospital. There are fears that even now, as it recruits extra staff, some people will not want to work there because they have seen the publicity.
Into that worrying situation I stepped, with four simple proposals. I wrote to my constituents asking whether they agreed with them. I proposed that those responsible for the management of the hospital on whose failings the Healthcare Commission reported should be replaced, that staffing levels should be corrected and retained, that there should be stronger powers for patients and the public, and that there should be an independent inquiry. So far more than 3,500 constituents have responded, and more than 90 per cent. of them agree with my proposals. I emphasise to the Minister that 3,500 people in the Stafford constituency think that there should be an independent inquiry.
Let me say something about the rebuilding of the trust board. We heard that the chair had resigned just before the publication of the Healthcare Commission's report. I shall not elaborate on what was said by Mr. Lansley about the treatment of the chief executive. Let me merely say how angry local people are about the fact that "step down" did not mean "resign" at the outset, the fact that he received pay while suspended, and the fact that he is now apparently being allowed to resign with no consequences while still receiving that pay. People are very, very angry about that.
We are recruiting a new chair, a new chief executive and new non-executive directors, and there will be a new board. At present, however, the trust faces the greatest challenges. An interim chair with another job in Sheffield and an interim executive with another job in Chesterfield are managing and leading the hospital. It is still a worrying time, and I ask for Members' support for the management and staff of the hospital as they try to do all the things that need to be done in the present circumstances.
It is true that the board needs to move from a closed to an open culture, but it has reverted to holding its meetings in public, and at the first of those meetings it reaffirmed its policy on whistleblowing. I showed the whisteblowing policy to Public Concern at Work, which made constructive suggestions for its improvement. The trust has agreed to write to every employee about the policy in this month's pay packet, confirming that people are free to make their concerns known if they have them. Those are all valuable developments.
It should also be remembered that the board is yet still to present its action plan in response to the report. It is now calling the plan its transformation programme, and I understand that it was agreed with Monitor at the end of last week. There have been some public presentations—for instance, to the overview and scrutiny committee, which has been dealing with the plan—but if we seriously believe that the public and patients should be involved in the trust in the future, we must accept that the plan will require full public consultation and approval. I am sure we will make certain that that happens.
I should like to say much more about staffing levels, but we are short of time. Although there is no agreed level for wards in this country—or internationally—the Royal College of Nursing has valuable policy guidance, which reminds us that a number of factors must be taken into account. In my view, the dependency levels of patients are an especially important factor; but so, of course, are nursing experience, a skills mix, a settled staff, minimum sickness and absenteeism and less reliance on agency cover, and all those factors affected hospital staff during the time we are discussing.
I agree that the handling of complaints was atrocious, and that we must adopt an "open and learning" culture. That will require constant dialogue between patients, their relatives, the public, and those who work at the hospital. It should not be a big thing to say that something is wrong at the hospital: people should be able to accept that and act on it. I have told Ministers before today that the LINk in Staffordshire is particularly poorly developed. We need to be helped to make it the best of its kind, not one of the weaker of its kind.
Let me now deal with the arguments for an inquiry. We do need an inquiry. The trust pulled the wool over the eyes of the Healthcare Commission for three years. In each of those three years, the commission produced improving assessments of a trust that it later said was so bad. Is the problem self-assessment? Does it constitute a failing of the commission itself that it received more complaints about this trust, in relation to its size, than about any other, and that it produced action plans in response to stage 2 complaints but did not pursue them to establish whether they were implemented? The chairman of that body said there was no need for a public inquiry, but one of the things such an inquiry would look into is the performance of his organisation.
There should be an investigation. The trust pulled the wool over the eyes of Monitor, as we have heard. The big black hole was about clinical care, where Ministers now accept there was a lacuna, but that has now been put right. Even in terms of Monitor's expert area of governance, management and leadership, the Healthcare Commission report tears the trust apart for secrecy, for as little as possible being reported to the board, and for as little as possible of the board's conduct being made public. Those issues should be investigated.
For me, the biggest issue is the independence of the case reviews for the relatives of deceased patients, because the trust has organised those reviews—albeit while bringing in outside clinicians who are independent of it. How can people feel trust in that system? Such reviews should be anchored in a public inquiry; and if there is a role to be considered for the coroner, that needs to be looked into as well.
All I want to say in conclusion is that 3,500 of my constituents have said there should be an inquiry, and the local councils—Stafford borough and Cannock Chase district—have resolved that there should an inquiry as well. The Patients Association has a national petition that people are signing, and the RCN supports this, and PACE 2000, an organisation of elderly people in my constituency, also thinks there should be an inquiry. That is a lot of people, and the Minister should listen to them.
This is a debate about freedom of information. It is a tale of cover-ups by two closed cultures: a cover-up by the hospital and its superior organisations, and a cover-up by the Government and their subordinate public organisations. That has resulted in a pincer movement of both death and despair. My constituents and the people representing the interests of the victims and the bereaved demand justice, and they will get justice only if they have a proper inquiry under the Inquiries Act 2005 because that will call for evidence on oath, and have compulsion of witnesses and proper legal protection for whistleblowers, which is not available under the Public Interest Disclosure Act 1998 as it is bypassed. I am saying not that the 1998 Act is bad in itself, but that it does not operate when certain people get to work on it. There are also good people at the hospital who need to be exonerated, and a public inquiry would provide for that.
There is now to be a Select Committee inquiry. That will give us the opportunity to present measured evidence, which we cannot do in 10 minutes tonight. I also ask my party's shadow Secretary of State to assure us that we would be able to have a public inquiry if and when we get into government next year, because that would be a good opportunity. I strongly suggest that the credibility of the Government is at stake—and I must say that I dismiss with contempt the Minister's recent trivial speech. Already, two governors have called for a public inquiry of the kind that is required and, as Mr. Kidney has said, Stafford borough council was unanimous in its demand for one.
I would like to quote from a statement from one of the nurses at this hospital. I want to read it out because it is very important. "X" and "Y" are my terms for two nurses:
"I spoke to X. I explained to her the situation and asked her to relay this information to Y. Whilst she did this she kept me on the phone. I heard her tell Y that I had discovered that several patients had breached. I then heard Y tell X to tell me to lie. X came back on to the phone and told me that Y's advice to me was to lie. I told her I was not happy to do this and explained that I had informed the clinical site manager of the breaches."
She went on to make another statement, again at a critical time. She said:
"I have become increasingly frightened in my place of work," and am
"feeling more and more threatened."
She quotes one of the nurses saying that
"you want to watch being in with her, a lot of people are getting fed up with her and she is going to get what's coming to her. You want to watch your back and be careful or you'll go down with her!"
She also refers to "the cumulative effect" and says that
"the net result has led me to feel quite terrified given the present context."
Then she talks about lying about the breach time and an occasion about which she said:
"This incident led me to feel profoundly shocked that a senior colleague could firstly blatantly lie about a patient's breach time, and secondly submit documentation, altered by her, in my name thereby knowingly leaving me open to disciplinary action."
The statement then contains reference to another patient and quotes that involve some effings here and there. Then she says in respect of a particular patient
"I have heard"— a nurse—
"state that she was going to get rid of him. Most recently following his hospital admission after taking an overdose I was present when she said 'He should have taken a few more pills and done the job properly.'"
"'what have you got in that ruck-sack Doctor, is it a bomb?'...'Him with the turban' or 'Her with the yashmak.'...'Him over there—Osama's mate'".
Things continue in the same manner. These allegations clearly have to be properly examined.
I am not using the names of the people involved, for reasons that I shall come to in a minute. The Minister will not deny that he has asked me why, if I have the evidence—for which people were shrieking when I raised the matter when objecting to our being prevented from having an oral statement—"I do not anonymise. I shall tell both him and the House why: when I did anonymise it, in a letter to the Secretary of State relating to a hospital nearby, the next thing I knew, after a considerable pause, was that the consultant in question had been suspended. Only last week, he was summoned for a Kafkaesque trial as if he needed to have a psychiatric assessment. I can tell the House that that consultant and the patient in question are constituents of mine and that consultant had saved the child's life. I am so furious that I cannot speak about it. This is the way things are carrying on and we hear these platitudes about whistleblowers being protected under the legislation.
The marvellous Public Concern at Work charity has made its criticisms, as the hon. Member for Stafford knows because we have been given the same material. The fact is that the whistleblowing policy in this particular hospital has to be reformed along the lines that we will explain later in the Select Committee—unfortunately, I have not time to go into this tonight.
I am holding a paper written by another consultant, who was suspended at one and a half hours' notice because he had had the temerity to complain about antibiotic policy—he had been with the hospital for many years. I must be careful, because I do not want to expose others to the kind of treatment that the consultant to whom I have referred has received. He was suspended after such a short a notice period on the issue of antibiotic policy and the non-availability of nurses on consultant ward rounds. This is a national disgrace and the legislation does not protect such people properly. The reality is that the allegations that I am making need to be properly examined by the Select Committee, when we have more time to do the job.
I move on to the question of the manner in which the Government have covered up. I mentioned, much to the Minister's hilarity, which I thought pathetic, that Ian Kennedy—he wrote the foreword to the Bristol inquiry—subsequently became chairman of the Healthcare Commission, produced the Stafford report and came up with a different version about the value of public inquiries. That was the point I was making. Ian Kennedy had said:
"A Public Inquiry cannot turn back the clock. It can, however, offer an opportunity to let all those touched by the events, in our case Bristol, be heard and to listen to others."
He had gone on to talk about the
"public venting of anger, distress and frustration; it provides a public stage on which this can take place."
I say again that if it is good enough for Bristol, it is good enough for us. He has obviously changed his mind since he became chairman of the Healthcare Commission, and I would like to get all that on the record.
Does my hon. Friend agree that Ian Kennedy—understandably, in the case of Stafford—was defending the Healthcare Commission, not least because when the Healthcare Commission undertook an investigation it would like not to feel that a precedent had been set that meant that it could be second-guessed by a call for a public inquiry? Does my hon. Friend accept that I do not see this necessarily as setting a precedent? We did not ask for an inquiry after Maidstone and Tunbridge Wells, nor would we set out to do so in other cases. The evidence in this case seems to point to such a wide range of unresolved issues that it demands that we go down that path.
I absolutely agree with my hon. Friend, and so does the Royal College of Nursing, which said that the focus on achieving financial targets at Mid Staffordshire was at the expense of appropriate and safe staffing levels and talked about cuts in the number of nurses.
As I said, the real question is also one of a Government cover-up. It has caused me a lot of difficulty to get some of these minutes, but there is no doubt that the minutes of the various strategic health authorities—I have them all, so I shall be able to go into them in due course, although not tonight—show a direct paper trail from the decisions that were made when David Nicholson was chairman of certain of these authorities that continued all the way through under the aegis of Ms Hewitt and also under that of the present Secretary of State. They are all about targets, finance and matters of that kind. Also involved is Mr. Bill Moyes. There is a conflict of interest for the university of Birmingham, which was commissioned by the West Midlands strategic health authority, and a conflict of interest for Mrs. Cynthia Bower, who is now chief executive of the Care Quality Commission.
The problem that troubles me is the continual conflicts of interest. For example, the university of Birmingham study was funded by the SHA, which set up the steering committee to guide the study. The people who were on the study that led to the analysis of the mortality rates in Mid Staffordshire included the medical director of the SHA and people from the trusts, including the information manager of the Mid Staffordshire NHS Foundation Trust. That is a blatant example of conflict of interest.
In conclusion, although there is much more information that I would like to get out, I shall simply say that we should consider the opening remarks and the constant references to finance, finance, finance in the Mid Staffordshire challenge-to-challenge board meeting. Bill Moyes, now of Monitor, who gave this trust status, said in the vital board-to-board meeting on
"questioning would concentrate on the financial viability and governance of the Trust."
It is a disgrace.
It might not be entirely evident from the previous contribution, but we Staffordshire MPs are a rather happy and consensual bunch. We meet regularly on a cross-party basis, and that is certainly unusual—it might even be unique in the House. We have been doing so for many years. When we met just last week, we obviously discussed this topic, and we came up with what we thought was a positive idea, which was that we should get all the various people involved in the case—the hospital trust, the primary care trust, the strategic health authority and the regulator—into a room to ensure that they were making things better. The emphasis today—quite rightly, as it is the focus of the motion—has been on settling the issues with the past. The other, and in some ways more pressing, side of the argument is the need to settle the issues with the future.
What the people we represent want is an absolute assurance that the problems in Stafford hospital are being sorted out, and that the kind of experiences that the Healthcare Commission report documented are not being repeated. We know that in some respects, at least, they are still being repeated. In some respects, however, they are not: as far as we can tell, the particular acute problems in the accident and emergency department have been resolved by increased staffing, better organisation and so on. However, the Alberti report tells us that there are still problems on the medical wards. The kind of problems that people come to my hon. Friend Mr. Kidney or to me with are basic care issues on the wards. Indeed, this weekend I was dealing with a problem, relating to exactly those issues, that is happening now.
Alberti tells us that there is still a real staffing issue on those wards. The implication is that the care is not good enough. It is to that that we must urgently turn our attention. As my hon. Friend the Member for Stafford said, Alberti also tells us that there are issues with staff not wanting to work in the hospital. "Who wants to work in Stafford hospital?"—so it goes inside the system. The hospital is desperately trying to get agency nurses in, because it cannot recruit normally. Real reputational damage has been done to the hospital, and there has been a real loss of public confidence locally. Those are all matters that need to be attended to.
As for the reports published so far, I have found them useful. It is difficult for people to say, in a general sense, that we do not know what happened at Stafford. I am afraid that we do know what happened at Stafford. It is difficult to say that we do not know why it happened; having read those reports, I think I do know why it happened. It is difficult to say that we do not know what to do, because we do know what to do to remedy the problems identified. I agree that there are outstanding issues; in a sense, there always will be. There are questions to which we still need answers, and some of them have been raised today. However, on the essence of the matter, I do not think that anybody can claim that we do not know what happened, why it happened, or what we need to do.
For me, the devastating part of the reports—devastating because it confirms the impression that I formed of the hospital from cases I had dealt with—was that there was a complete inattention to patients. There was a preoccupation with process. All the reports that have been produced say that. They all identify that as the key issue. That raises many questions about how on earth a hospital could have taken its eye off the ball so comprehensively as far as patients were concerned. How could it not have understood that the quality of patient care is central to all that it does? The reports talk about the problem of culture inside the institution. "Problem of culture" means not understanding that patient care is central. It means not having set a standard of patient care, around which everything is organised. I am afraid that what the reports tell us about the failure to use complaints intelligently is simply part of that. I speak as someone who has taken a perverse, obsessive interest in complaints over many years.
We all know, if we are honest, that we never got the system of complaints inside the health service right. I remember sitting on inquiries into complaints in the health service under the previous Government, when it was widely recognised that we had a problem. There have been endless inquiries since then into how we can improve complaints systems. We have set up different systems and tried them out; they have failed, and we have tried new ones.
I remember listening a few years ago to the permanent secretary of the Department of Health, I think it was, describing how he wanted every patient who came into an NHS hospital to be given what he called a "three Cs" form. The three Cs were comment, complaint and congratulation. I thought that that was sensible, but when I asked him whether the forms would be universally available in every hospital, he said no; they would simply be available if people wanted to use them. I think we ought systematically to make sure that every in-patient in every hospital in the country is asked for their comments, complaints and congratulations. Having done that, however, we must ensure that in every institution we learn in a systematic and serious way. It is no good simply getting people to tell us things if we do not learn from what they have told us and act on it. There is no reason at all not to do so. Lord Darzi's intervention is extremely valuable in reminding us of something of which we should not need to be reminded: that the quality of patient experience is absolutely central to what the health service ought to be about.
I thank the hon. Gentleman for giving way in the interests of comity in Staffordshire. Does he agree that there is a serious problem with targets and money? Although he may not have seen the report, in the board-to-board meeting on
My view is that that was overwhelmingly a particular problem in that institution. Indeed, on the day on which the Healthcare Commission report was published, its chairman, Sir Ian Kennedy, to whom reference has been made, went on the radio to say that the NHS was steadily improving. I believe that that is the case, and I speak as someone who uses the NHS heavily. Indeed, I was in hospital this morning being attended to. My experience over the past 10 years is that it is steadily improving. However, there is no question of its improving over the years in Stafford, because the trust did not understand the centrality of patient care.
I want to spend the last couple of minutes on the inquiry. I am not going to vote against the motion, but I am not going to vote for it, either. There is a real problem with capturing the advantages of a further inquiry, given some pretty demonstrable disadvantages. The advantages are clear: there are questions still to be answered, and there are certainly people on the ground who have been personally affected and whose questions remain unresolved. However, we must not think that a further inquiry does not involve costs. If we are to achieve a relentless focus on improvement, I am not sure that that will be aided by a relentless focus on the past. I want assurances that we can have a further inquiry to tell us things we do not know, but without it carrying the great disadvantage of our taking our eye off the ball and failing to do the things locally that we have to do.
Five years ago, the Committee that I have the privilege of chairing produced a big report on the whole question of inquiries. The Inquiries Act 2005 was being introduced, and the Government gave evidence to us. We had asked them in what circumstances they would hold an inquiry, and they said:
"There is no standard blueprint for the type of circumstances in which an inquiry might be needed. Matters triggering inquiries are by their nature difficult to foresee."
"A common theme tends to be that the subject matter of the inquiry has exposed some possible failing in systems or services, and so has shaken public confidence in these systems or services either locally or nationally".
On those grounds, there is no question but that Stafford fits: it has shaken public confidence, and the problem is of sufficient severity. We tried to do a little better—I do not have much time, so I shall abbreviate my remarks—by producing a checklist of questions that were sensible to ask when the issue of an inquiry arose. As MPs, we ask for inquiries like children ask for sweets—it is what we do—so there is a discipline in having to ask such questions. I do not have time to recite them all.
Given the point that the hon. Gentleman made about diversion, does he not accept that nurses working at Staffordshire general hospital, as reported to me by the general secretary of the Royal College of Nursing, wanted a public inquiry?
Indeed, and I want an inquiry that tells us some of the things we do not know, but if we are being fair, those people urging a further inquiry have also to be fair and recognise that there are potential risks and dangers in having one. We all want to settle accounts with the past, but we also want to make sure that urgent improvements are made now.
I end by quoting from Professor Alberti at the end of this report. With reference to Stafford he says:
"The Trust has the potential to become a model small to medium-sized hospital of the future with care delivered promptly and appropriately both in the community and in the hospital—and with poor patient experience a dim and distant memory."
That has to be our objective.
In talking about inquiries, the question is whether we can capture some of the advantages of holding a further inquiry while offsetting the very evident possible disadvantages in pursuit of that objective. That is the conversation I intend to have continually with the Government. The Secretary of State has said several times to several of us that he would be happy to have a further inquiry if he thought it would do any good. It is our job to explain to him that it might do some good without doing some harm.
Dr. Wright, whom it is my privilege to follow, spoke about the criteria that the Government believe in for a public inquiry. One of the criteria he mentioned was that of systemic failure. The problem that faces us in Staffordshire is one of systemic failure, but it is systemic failure that exists in other hospitals too.
Before I go any further, I echo the opening words of my friend Mr. Kidney by saying that, as a Conservative MP, I support the national health service, and as a Conservative MP, I support the workers in the NHS, particularly the workers in Stafford hospital, who at present work under such difficult conditions and who, I am sure, will look at the contents of this debate.
I said that there have been systemic failures. My hon. Friend Mr. Lansley, the shadow Secretary of State for Health, mentioned the problem of whistleblowers. At a previous Health questions I said to the Secretary of State for Health that there was another example provided by two people who work in my constituency—I did not give their names because they are terrified that if their names were known, they would lose their job. They work at another hospital in the west midlands and showed me photographs that show disgraceful and unhygienic conditions in that hospital, but they would not leave the evidence with me, which left me in a paralysed situation because I could not do anything without the evidence.
At the time, the Secretary of State told me that he was amazed that despite the protections that exist for whistleblowers, such huge fear still exists. Once again, the Secretary of State, who, I have no doubt, is a good man and has the best interests of the national health service at heart, said that he was "amazed" that whistleblowers did not speak out at Stafford hospital. As my constituents said to me, with nurses, doctors and even consultants being made redundant, would they be next? That is the issue that faces all those who work at Stafford hospital or other hospitals that may not have such acute problems but nevertheless require the shining light of publicity, or at least exposure.
The report came out a few months ago and spoke of systemic weaknesses that have existed over the past three or four years. However, I spent a day with a paramedic crew from the old Staffordshire ambulance service, before it became a part of the West Midlands ambulance service. The crew said to me in 2000, "Mr. Fabricant, if, God forbid, anything happens to you or your dearest, don't send them to Stafford. If you have to go to A and E, go to Burton hospital, because the survival rate is far greater there." I believe that the problem has existed for many years and is not just a recent occurrence.
We have heard about the evidence from nurses. One nurse provided senior managers with details of her concerns in November 2007, but they were ignored. Her report talked about doctors and nurses being ordered to discharge people who were critically ill and, as we have already heard from my hon. Friend Mr. Cash, to lie about how long others were waiting.
The nurse documented cases, including that of an elderly patient who died the day after being sent home against her doctor's wishes. The lady concerned, who suffered from a bowel condition, had been taken to A and E suffering from acute abdominal pain, and anyone who has been to medical school for just a year and a half, let alone longer, will know that acute abdominal pain needs to be examined very seriously. It turned out that she had a perforated bowel, but she was sent home because that was the ethos at Stafford general hospital. The nurse said:
"I will never forgive the moment when the patient clasped my hand and said 'Am I going to die?' I can't say that she would definitely have been saved if she had been given the right care, but at the very least she should have been given some comfort and dignity."
Despite the disadvantages that the Minister and the hon. Member for Cannock Chase have pointed out, I passionately believe that we still need a public inquiry, not to look to the past, but to provide lessons so that we can avoid the situation in the future at Stafford general hospital and stop the instances that I discussed a few moments ago which prevent whistleblowers in other hospitals from making their views known. A public inquiry is important for our constituents, and I commend the hon. Member for Stafford for having the courage of his convictions and saying that he will vote tonight for an inquiry. His constituents, like mine and others in Staffordshire, all want to feel that justice will not only be done, but be seen to be done, and that there will be lessons learned and additional protections not only at Stafford general hospital but at hospitals in other parts of the country.
The Under-Secretary of State for Health needs to answer some questions, and I should be grateful if she addressed them in her winding-up speech. First, does she think it right that the former chairman of the West Midlands strategic health authority, Cynthia Bower, is now in charge of the Care Quality Commission, the actual body that is responsible for monitoring the progress of Mid Staffordshire NHS Foundation Trust? Surely that is a conflict of interest. If there is not a public inquiry, what action can the Minister take to restore faith in Stafford general hospital among the residents not only of Stafford but of other parts of Staffordshire?
How will we recruit nurses? We have already heard that there is a recruitment problem, because Stafford general is now branded a hospital that we would not wish it to be. One has only to read the comments in Staffordshire newspapers, such as the Stoke Sentinel, the Staffordshire Newsletter, and the Express and Star, to know the very real concerns that people continue to have about health care in the area.
What progress is being made towards a coherent five-year plan for the trust, as recommended by the Alberti report? Still we hear that medical care on the wards is not as it should be. What progress is being made towards recruiting experienced surgeons for night shifts at the hospital? That is still a real problem for a hospital with an accident and emergency department. Finally, can the Minister give assurances that, at hospitals nationwide and not just at Stafford, patients are not simply being dumped outside accident and emergency wards so that the four-hour waiting time targets can be hit?
As I mentioned earlier in an intervention, such things happen not only at Stafford hospital, but here in Westminster—I have seen it for myself. Yes, targets can be good; I am not saying that we should have no targets at all. But not to accept that targets can endanger and distort clinical care is to live in a dangerous fantasy that puts the lives of all our constituents at risk.
I commend Mr. Cash for his powerful comments. He has been attacked because he did not come to my debate on whistleblowing; it was said that he had not taken every opportunity to participate in debates. I should defend him. As that debate was so short, I said that I would not take any interventions and I encouraged him not to come.
Having got that off my chest, I turn to the Minister's contribution. He said that he might change his mind. The whole point of debates in this place is to give people a chance to change their minds. I have changed the mind of only one MP during my whole career here—but as I have done it once, I have every hope of doing it again. My presence here shows that the concerns go wider than Stafford. Dr. Wright implied that we know why it all happened, but I do not think that we know enough. We have to find out more, so that the same does not happen anywhere else.
I have looked through the Healthcare Commission report in some detail because I am very bothered about why there were no whistleblowers. The Minister himself stated that staff did not put their concerns on record, and Norman Lamb also implied that. Actually, what they say is not correct; the report shows that concerns were raised. I shall pick out some bits of it to show that. Page 37 states that
"Many clinical staff told us of their concerns about the quality of care at the trust and gave specific examples."
Further on, the report states:
"In September 2006, a paper to the hospital management board highlighted how the one in two on-call rota, with the two consultants taking turns to cover, was not tenable."
Page 45 refers to the same paper's reference to the inadequate level of middle-grade staffing. Page 46 mentions that the regional postgraduate dean drew attention to problems of the training and supervision of middle-grade doctors.
Page 47 contains a long paragraph, which I am afraid I am going to quote:
"In April 2005, the medical division identified a risk that there would be too few staff to support the service due to failing to replace staff who terminated their employment. This was recorded on the risk register, but no review date was provided. In July 2005, it was noted that future demands of the service may not be met due to insufficient levels of staff in the department. From these entries, it is evident that staffing levels were considered to be inadequate as far back as 2005."
Page 47 also refers to a review by the Heart of England NHS Foundation Trust that was critical of the level of nursing supervision. Page 62 describes reconfiguration of the medical wards in 2006, which led to changes in the skills mix of the nursing staff that were unacceptable to many consultants.
Does the hon. Gentleman accept that the details of the Healthcare Commission report clearly demonstrate that the board was spending too much time on finance and matters of that kind? As I demonstrated from the minutes, this goes right the way back to the early decisions that were taken by the strategic health authorities, which were based on targets that are part and parcel of the national health system as a whole, as run by the current chief executive of the NHS.
I thank the hon. Gentleman for that intervention. I will come to exactly that point a little later, because there is a quote about it in the report.
Another important part of the report, on page 63, concerns high levels of staff sickness and complaints to the commission that had not been taken up. On page 93, there is an absolutely vital table that summarises some of the findings about the trust's approach to levels of nursing staff. It says:
"In 2002, the review of clinical governance by the Commission for Health Improvement pointed out that the number of nurses was low compared with other similar hospitals."
It also says:
"In 2005, the trust had more wards with below the national average number of nurses than wards with above the average, by almost two to one."
Anybody who reads page 93 can pick up on several similar points.
Why did all the long-standing concerns that had been expressed never get through? We have to find out where the blockage was. Was it between the working doctors and nurses and their clinical directors or nurse managers, or between the clinical directors or nurse managers and the medical director and the director of nursing? Was it held up above that level, by the chief executive preventing it from getting to the board? There are some clues about why senior staff perhaps did not make more effort to take matters wider. Page 101 of the report says:
"Staff, including senior staff, had little confidence that the trust learned from incidents."
On page 106, the Healthcare Commission says:
"We did not gain an impression from staff that the trust had had an open culture in which concerns could be raised, were welcomed and resolved. We have noted above that several consultants considered that the trust did not welcome criticism or concerns."
On page 108, we see the point raised by the hon. Member for Stone:
"The minutes of the board show that finance and achieving foundation trust status were given high priority. There was little recorded discussion about quality of care."
There are still questions about where these complaints were held up. Why were whistleblowers not going higher to the Royal College of Nursing or direct to the strategic health authority? I hope that we will ask those questions at the Health Committee meeting dedicated to this problem.
The Health Secretary has made some useful suggestions for the future, but I am currently much more interested in the past. That is why I believe that an independent inquiry is essential and should not be deferred. We want the people who have got us into this state, not those who are trying to get us out of it, to appear before an inquiry. We know that many new young consultants have been appointed who have nothing to do with what has happened and that there are new interim executives. Surely we could separate the people responsible for what has happened from those who are interested in the future. I strongly support the plea for an independent inquiry to satisfy staff—and exonerate those who had nothing to do with it—relatives and patients. At the same time, it is crucial to continue to make improvements for the future. However, I believe that different people are making the improvements from those who caused the problems in the past.
As a member of the Select Committee on Health, I intend to make only a brief contribution. Like Dr. Taylor, who is also a member, I look forward to taking evidence and listening to what people have to say.
I thank my hon. Friend Mr. Lansley. The subject is unusual for Opposition day debates, but the issues that it raises are important for us all and the NHS generally. At least, we have put pressure on the Government and asked them more questions about outcomes and what is happening.
Four hundred people may have died as a result of what happened. If a jumbo jet had fallen out of the sky or been blown up, or a major train crash had occurred, there would be a public inquiry. I understand the Minister's comments about the length of time we have spent and so on, but we are considering individual and family tragedies, about which people want their say. They want to listen to other people's evidence. That is important for not only the grieving process, but the community around the hospital, who look to it to care for their family and friends, and feel let down.
We also need a public inquiry because staff have been put under tremendous pressure in the hospital. We have heard many examples of people who have been forced to input data into computers and use all sorts of methods to deal with the target regime. I appreciate that staffing levels have improved, but when a hospital gets a bad name, it is difficult to get people of high quality and calibre back into that hospital to turn things around.
My hon. Friends and Labour Members who are present, for whom I have great respect, have called for a public inquiry and there is a general view that we need to examine the matter more deeply and reflect on the issues that have been raised.
There are several concerns. I broadly welcome foundation trusts, but, as has been said, I was amazed that we ended up with a foundation trust, when, apart from the Secretary of State's recommendation, the evidence was based on various tiers and organisations in the NHS, which were all thought to be robust. That turned out not to be the case when foundation trust status was granted in 2008.
I welcome the Minister's comments at the beginning of the debate about the steps that have been taken to improve the service. The Care Quality Commission, the PCT and Monitor will monitor the hospital after three months and six months and devise further action plans to improve its outcomes.
I welcome the comments of my hon. Friend the Member for South Cambridgeshire about the need for tougher inspection to root out failure and for a much stronger voice for patients. The old community health trusts were a pain in the arse, if I can say that—
Mr. Deputy Speaker is reflecting on that.
However, the community health trusts were the genuine voice of the patients. We have moved through various different models and, to be honest, there is not a big enough voice for patient organisations, which pick up what is being said at the grass roots. If the Government had not been so quick to get rid of the community health trusts, the warning signals would have gone off rather earlier.
We need powers for patients to hold failing hospitals to account. We need an end to box-ticking and targets. Indeed, we have heard the reverse: that outcomes are important, not targets, because when people are under pressure, they will be made to get round targets. We need to expose hospitals that are failing their communities to public scrutiny.
This has been a reasonable debate and there have been some good contributions. I agreed with a lot of what the Minister said earlier, but I did not agree with his stubbornness. I am sure that the civil servants are saying, "Don't go for a public inquiry, Minister. It'd take too long and be expensive, and things are happening already." I intend to support my hon. Friends in the Lobby. Even if the Government win the vote this evening—it would be very surprising if they did not—I hope that Ministers will go away and reflect on what opinion in all parts of the House is saying on the matter.
We have had an important and comprehensive debate that has been characterised by cogent, balanced and sincere contributions—indeed, one could almost describe them as pleas—from all parts of the House, as befits such a gravely serious issue. It is an issue that must reach beyond party politics.
We must remember that, at its heart, we are talking about the avoidable deaths of up to 1,200 people. Each of those deaths represents family and friends who are left with the heavy burden of grief, which is only intensified by the serious questions that need answering. Furthermore, those deaths can only be correlative to many hundreds more patients who did not receive the treatment that they deserved—treatment that they rightly expect of our NHS. Before going any farther, we must take a moment to remember all those who have suffered and who continue to suffer and grieve because of the failings at the Mid Staffordshire trust. Equally, let us keep in mind the wonderful work of the individuals and teams working across the NHS who have been so badly let down by what has happened in Stafford general hospital.
We have brought a very simple motion before the House today. This is not the moment to knock the Government particularly harshly, although it is clear that there is a continuum of culpability, which extends from the local decision makers to Ministers and, more significantly, calls into question Government policies. Our motion this evening does not seek to apportion blame for the Mid Staffordshire tragedy. Indeed, every speaker has agreed with us and with our motion, other than the Minister and the honourable exception of the Chairman of the Public Administration Committee, Dr. Wright. He said that he would not vote against the motion. He remains to be convinced whether to join us in the Lobby and might just be persuaded—and I hope to try.
Our motion simply calls for an independent inquiry, which the relatives of those who died and the survivors of poor care at the trust both need and deserve. The important point is not just what went wrong, but how and why it did—a point forcefully made by Dr. Taylor, who, with his professional point of view, has a double interest in understanding that—and what must now be done to prevent it from happening again. That is a point to impress upon the hon. Member for Cannock Chase, because unless one understands the past, it is very difficult to move on and ensure that the right things are done for the future.
Despite those wonderful NHS staff, Mid Staffordshire and Stafford general hospital have been blighted, as my right hon. Friend Mr. McLoughlin said in an intervention, when he gave personal testimony of the most wonderful care that his mother received. The problem extends way beyond the people in Staffordshire, but we heard powerful arguments from my hon. Friend Mr. Cash, whose speech not only carried the House, but was redolent of what it means to try to seek justice. He argued forcefully, using evidence that he was able to give only partially, but which would be available in a public inquiry, that the only way to secure that justice would be in a public and independent inquiry.
The Government have said that they remain unconvinced, which carries the implication that they could be convinced, and we all hope that they will be, following tonight's debate. They will only have had to listen to the excellent speech of my hon. Friend. He asked directly whether the official Opposition would consider initiating an independent public inquiry, and I can tell him that we do not exclude the possibility, if we are in office, of establishing such an independent public inquiry. However, I emphasise that today's debate is taking place because the people of Staffordshire and beyond want an inquiry to be set up now, so our efforts need to be focused on that, not least to persuade the Government to do just that.
My hon. Friend Michael Fabricant focused on the justice of the case, and on what lessons could be learned straight away, right across the NHS. He said that it was necessary to have an inquiry in order to assuage the public's concerns from the past and to learn all the necessary lessons for the future. With local and national health officials, Ministers and Government policy implicated in the problems, it is difficult to contend that a review conducted by officials in the Department of Health will deliver the thorough, all-encompassing, plain appraisal needed to reduce the chance of this happening again.
I want to take my hon. Friend one tiny stage further in his answer to my question. Will he also bear it in mind that the Leader of the Opposition, my right hon. Friend Mr. Cameron, was a parliamentary candidate in Stafford, and that he has taken a specific interest in this hospital, for all the right reasons? I am sure that my hon. Friend and the shadow Secretary of State will want to have a word with him about this.
I am absolutely sure that such words will be had. My right hon. Friend the Leader of the Opposition went to see for himself on
My hon. Friend the Member for South Cambridgeshire, in his close exegesis of the Colin-Thomé and Alberti reviews, described why both reviews were limited in their scope. He said that the reports lacked the independence required to give them sufficient perspective on the events, to call people properly to account, or to satisfy the needs of families and survivors in Staffordshire and beyond. The reports have not given the people of Staffordshire an opportunity to make the points and to ask the questions that they feel are important. Neither Colin-Thomé nor Alberti held public evidence sessions to provide an opportunity for depositions and questions to be asked by the bereaved and the survivors. As a result, the reports do not show the necessary rigour in relation to the culpability of NHS officials, the Department and the Government, either in political or executive terms. Such rigour is necessary to provide the answers for the people of Staffordshire, and to prevent such a tragedy from occurring again.
I cannot fully answer the hon. Gentleman's question, but I am sure that he will be pleased to know that Dr. Colin-Thomé and Professor Alberti have agreed to come to Stafford and to face an audience consisting of members of the public and the relatives of those who died, in order to answer their questions. I am sure that the hon. Gentleman will welcome that as a good step forward, although it does not provide a complete answer to his question.
I am grateful to the hon. Gentleman for that intervention. He made an important speech on behalf of his constituents this evening, and I look forward to welcoming him into our Lobby this evening. I also welcome the opportunity for questions that he has just mentioned. However, as I have just said, the opportunity for those people to answer is limited by the scope of their reviews, which is never going to be as wide or as deep as that of an independent public inquiry.
We need to ensure that we keep our discussion focused on the Ministers who have the power to make this decision, rather than on two well-respected people from civil service and departmental backgrounds. I hope that the Minister will recognise that we need to understand why lacunae exist in both reports, and tell us what role Ministers had to play in that. David Colin-Thomé and Sir George Alberti are civil servants employed by the Department of Health, and have been for a number of years. They may take to heart the independence of the civil service, but I think that the House would agree that they lack independence so far as their interest as members of the Executive, through the Department, is concerned.
For example, the House will be aware that the chief executive of the Shropshire and Staffordshire strategic health authority in 2005 to 2006 is now the chief executive of the NHS, and that the subsequent chief executive of West Midlands SHA is now the chief executive of the Care Quality Commission. A necessary requirement of any review should be to lay bare the management of the SHA between 2002 and 2008, and to provide an opportunity for the reputations of these two very senior civil servants in our NHS and the Care Quality Commission to be cleared.
It is clear that West Midlands SHA failed in its duty of performance management; it was more bothered about Department of Health initiatives, finance and reconfigurations and relied on performance assessment bodies to consider the quality of patient care. Cynthia Bower, now of the Care Quality Commission, only once raised mortality rates, for instance, in her routine briefings to the board. It would be helpful to have an independent public inquiry at which many other issues could be addressed and Cynthia Bower and others would have an opportunity to give their side of the story.
In the Alberti and Colin-Thomé reports, there is little evidence of any rigorous treatment of the impact of the Government's policies on the trust. Although Ministers might say that the policies are in no way linked to the events that occurred, if they were that confident, would not an independent public inquiry provide a stronger opportunity for them to disprove any such link between their policies and anything that took place at Stafford general hospital?
Three of the solutions identified by David Colin-Thomé are actions that should be taken by the Department of Health. That suggests that, in his mind, there are three actions that the Department might have taken to avoid the tragedy happening. Hon. Members might assume from that that the Department of Health would be mentioned at least three times in the body of the review—yet the Department of Health is not mentioned once in its substantive body.
Clearly, we can see the effect of the chaos arising from the near-perennial reorganisations of the NHS and the suppression of a powerful patient and public voice. Like my hon. Friend Mr. Syms, I hark back to the late lamented community health councils that were killed off by this Government, as they were independent and able to aggregate individual circumstances to draw general conclusions that were extremely helpful in advising Governments and the public about the performance of the NHS. We also have to remember the failure to act on events at Maidstone and Tunbridge Wells. They all had a part to play in the tragedy.
It is vital to remember that, in his opening remarks, the Minister mentioned that there was continuing contempt—certainly on the basis of the discussions we have had—for a real complaints process in the Care Quality Commission and the Healthcare Commission. We have advocated proper complaints processes, but they were refused by the Government, who have relied on an over-burdened and under-resourced health services ombudsman. An independent public inquiry would be able to demonstrate how these processes should work.
In arguing the case for an independent public inquiry, it is important that both the policy and the individuals are properly scrutinised. The Secretary of State said that he remained unconvinced, but we hope that the right hon. Gentleman, who promised Julie Bailey of the Cure the NHS campaign that he would think again, will actually do so. We salute that campaign and we hope that when the Under-Secretary replies, she will do the right thing, support our motion and launch the public inquiry. On behalf of all those who are grieving and those who have suffered, we hope that she makes the best and shortest speech she has ever made and simply says "yes".
The events at Stafford hospital were totally unacceptable. The hospital badly let down its patients and their families, and it has let down our national health service—an institution that has been providing the very highest standards of care for more than 60 years. I worked as a nurse in the NHS for more than 25 years and whenever the tragedies, complaints and reality of what happened at Mid Staffordshire become clear to us when we read these reports, we feel shame and we feel that we have let many people down.
I would like to thank Professor Alberti and Dr. Colin Thomé for their timely and informative investigations. I am sorry that the Opposition Front-Bench team feel that their lack of independence in any way deflects from their absolutely renowned work as well-respected clinicians. I feel that the reports have, quite rightly, been critical. Those, combined with the original report of the Healthcare Commission and the ongoing reviews of individual patient records have brought, and continue to bring, rigour, clarity and understanding about what happened at Mid Staffordshire and the reasons behind it.
My hon. Friend the Minister of State gave way so many times and I have only a few moments. I will consider giving way as I continue.
I believe, however, that the hospital has, importantly, begun to start to make the significant improvement to patient care and safety that we were looking for and that, certainly, those who use Stafford as their hospital were looking for.
The Healthcare Commission, the independent regulator expressly established by Parliament to scrutinise and investigate the NHS, has conducted a full investigation and produced a detailed report laying bear the failures at Stafford hospital. The reviews from Professor Alberti and Dr. Colin-Thomé provide us with further reassurance in relation to the trust and greater insight into the reasons why those failures remained undetected for so long. In addition, the trust has invited in people who are not just concerned, but devastated, about the care that they or a close relative—a mum or a dad—received. What those relatives feel about the care at Mid Staffordshire goes right to the core of us as people.
On the request for an independent clinical review, that process is under way and, to date, about 85 reviews have been requested. Those will be difficult and painful, but I believe, like many others, that the fact they are being taken in this way shows that this is the best way forward.
Order. Really, the hon. Gentleman knows well enough that he is trying to gain an intervention on the back of a point of order, which is not valid.
Thank you, Mr. Deputy Speaker. I hope that the House understands that I have many points, raised by hon. Members, that I want to respond to. I would like very much to try to do that.
In the light of that, we believe that a public inquiry would, at this stage, obviously be very time consuming. It would add little more to our understanding of what happened and distract the new management and staff from improving the quality of care for local people, which we so want them to do.
Public inquiries can be an important mechanism independently to establish the cause of a problem or a disaster, and I can understand that there are many who consider a public inquiry into the events at Mid Staffordshire to be appropriate and necessary, but in this case, even Sir Ian Kennedy, who we respect so much and who chaired the public inquiry into the tragic events at Bristol royal infirmary, has said that he does not feel that one is necessary.
There has already been an independent examination of what went wrong and a public account of the failure at Mid Staffordshire, but if hon. Members believe that there are significant issues or lines of inquiry that have not been addressed, either by the Healthcare Commission report or by the subsequent reviews, the Secretary of State will be only too happy to consider that. That also appears to be the view of Opposition Front Benchers. Mr. O'Brien said that even Opposition Front Benchers have not ruled out that possibility, so I am at a loss to see what is the difference between the two sides of the House.
The report commissioned by the Secretary of State tells us—
Order. I understand the hon. Gentleman's strength of feeling on this matter, but that is shared by colleagues across the House. The Minister must be allowed to make her winding-up speech.
On a point of order, Mr. Deputy Speaker. Before there is any danger of a possible distortion of any words and any commitment that we have given, I hope that you can assist me in ensuring that the record, including that of the debate, shows that we gave an undertaking that we would look at ordering an independent public inquiry in the absence of the Government ordering one now, which is where our efforts are focused.
The record will show, Mr. Deputy Speaker.
I wish in particular to mention the Royal College of Nursing. It is our understanding that since the publication of the two reviews, the RCN is calling no longer for a full public inquiry but rather for a review of any new issues.
Many hon. Members have taken part in the debate, but the issues that the Opposition Front Benchers raised shared the theme of whistleblowing. I intend to address that, but I am sure that hon. Members will understand it if I praise my hon. Friend Mr. Kidney.
I have said that I will not give way.
The reality is that Sir George Alberti and Dr. Colin-Thomé have agreed to present their findings about what happened at Stafford at a public meeting in Staffordshire. I understand that my hon. Friend the Member for Stafford is facilitating that meeting, and I congratulate him on that. He is aware of the importance of the recruitment of good-quality staff at Mid Staffordshire, and that issue was raised by the hon. Members for Lichfield (Michael Fabricant), for Stone (Mr. Cash), for Wyre Forest (Dr. Taylor) and for Poole (Mr. Syms). My hon. Friend Dr. Wright reminded the House of how we have to work together to see that these incidents do not happen again.
If I may go into the heart of the problem at Mid Staffordshire, it is about reporting bad care and whistleblowing. Our next stage review by Lord Darzi is about quality and safety. We cannot have quality and safety in patient care, which is paramount to every health professional, if we do not have the appropriate work force. Every patient journey must start by having quality and being safe. We cannot have safety if we do not operate in an environment of an open culture and a management who show real leadership. That encouragement of leadership at all times throughout the review has raised the quality of leadership within the Mid Staffordshire trust.
It was this Government who brought in a whistleblowing charter. [Interruption.] Opposition Members may shout, but if they are concerned about the reality and quality of patient care and safety, I suggest that they work within the next stage review at all times, because the quality and safety of patient care are paramount. I appeal to the new leadership that is in place at Mid Staffordshire to get in place the consultants, nurses and health professionals who can provide a quality work force, so that they can lead quality patient care and so that Mid Staffordshire is known as a centre of excellence in future. We shall bring that about through our education and training system.
The Prime Minister has commissioned a commission on nursing and midwifery, which I am privileged to chair. I shall attend Mid Staffordshire trust to consult nurses about how they feel things went wrong. With the serious comments that have been made in the House, we need to address why people did not feel they could report such serious incidents. From the top doctors to everyone else who works at the hospital, from the ward to the board, every one of us is responsible for patient care, and every one of us will continue to administer the quality and safety that our national health service should deliver, and that our patients have every right to expect us to deliver.
Question put (
Question accordingly negatived.
Question put forthwith (
Question agreed to.
The Deputy Speaker declared the main Question, as amended, to be agreed to (
That this House notes the independent report by the Healthcare Commission which identified severe failings at the Mid Staffordshire NHS Foundation Trust and the follow-up reports by the National Clinical Director for Emergency Care and the National Clinical Director for Primary Care which state that Stafford Hospital's accident and emergency department is now safe but that further improvements must be made at the Trust and lessons learnt by the whole NHS; further notes that the hospital has offered independent reviews of clinical records to all concerned; agrees that at the present time it would not be appropriate to establish an independent public inquiry; further agrees that management and staff at the hospital must remain focused on delivering high quality patient care; and further agrees that an independent public inquiry could add undue delay to implementing the recommendations of the above reports and therefore to the hospital delivering high quality and safe services for the local community.