Accountability and Transparency in the NHS

Part of Justice Committee Report: Youth Justice – in the House of Commons at 4:43 pm on 14 March 2013.

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Photo of Neil Carmichael Neil Carmichael Conservative, Stroud 4:43, 14 March 2013

This debate has been thorough and, at times, moving. I congratulate my hon. Friend Charlotte Leslie on securing it. I was impressed by the moving speech of Ann Clwyd because it demonstrated the tragedy that lies behind this debate.

The Francis report is a disturbing document in many ways. The Prime Minister and the Secretary of State for Health are right that we should not be looking for scapegoats. I do not want us to find any scapegoats and I am sure that you, Mr Deputy Speaker, do not what us to find any scapegoats. We must remind ourselves what a scapegoat is: it is somebody who gets the blame for somebody else’s behaviour. The question that we must ask is who is responsible. That is at the core of this debate. If we cannot find out, we must produce a system that has a mechanism for responsibility.

When someone accepts responsibility, it is refreshing and empowering. If a manager avoids that responsibility, they are effectively acknowledging that they are weak and insufficient at their job. If someone cannot answer those questions and does not feel able to say, “The buck stops with me”, they are not doing their job properly. We need to think about that system of responsibility and accountability.

Can gagging be consistent with effective, decent line management? Absolutely not. A person is effectively saying that someone beneath—or even above—them cannot say what they need to say. A show cannot be run with that kind of mechanism, and we should certainly not be content with the number of gagging clauses we have heard about today. I welcome the end of gagging clauses, and pose the same question that others have asked the Secretary of State: is the move retrospective?

Line management is also about culture because we must be able to trust people when we ask for something to be done, and know that the message is getting out and is clear and fair. That is what good management is. It is not just an issue in the health service; it is an issue in any organisation, and that brings us to the overall question of governance. Governance applies everywhere and must be accessible, transparent and something in which people have confidence. As hon. Members have pointed out, there is far too much buck-passing and evasion, and that will not help us arrive at a decent culture for patients, which is what we should be focusing on. Of course we are right to talk about “patients” rather than “targets”, but we also need patients to feel comfortable with the system in which they are operating.

My hon. Friend Nick de Bois made a good point about speaking out. Many of us can speak out and do so nearly every day on a variety of subjects. Some patients cannot, however, and need additional advocacy that sometimes does not come easily to them or their friends and family. Just imagine them in a management system in which people cannot listen or talk to each other, let alone take into account the views of patients!

We must have a change of culture and, as the old saying goes, a fish rots from the head. This is about leadership and shaping a culture that effectively manages to spread out everywhere. That culture must be inclusive, transparent and open and effective at empowering people at every level, rather than shutting them down and isolating them in systems that are too complicated to feel comfortable in.

Finally, I welcome the appointment of a chief inspector for hospitals. That is a necessary appointment and will make a huge difference. They must, however, look at the leadership of what he, or she, is inspecting. Leadership is fundamental and matters, and we must ensure it is responsible and accountable.