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Hospital Mortality Rates

Oral Answers to Questions — Health – in the House of Commons at 1:10 pm on 16th July 2013.

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health 1:10 pm, 16th July 2013

I would like to make a statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.

Let me start by saying that in the health service’s 65th year, this Government are deeply proud of our NHS. We salute the doctors, nurses and other professionals, who have never worked harder to look after each and every one of us at our most vulnerable. We recognise that the problems identified today are not typical of the whole NHS or of the care given by many wonderful NHS staff; but those staff are the ones who are most betrayed when we ignore or pass over poor care. The last Government left the NHS with a system that covered up weak hospital leadership—[Interruption.]

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Thank you, Mr Speaker. The last Government also failed to prioritise compassionate care. The system’s reputation—[Interruption.] This is uncomfortable for hon. Members. The system’s reputation mattered more than individual patients; targets mattered more than people. We owe it to the 3 million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head-on.

Following the Francis report into the tragedy at Mid Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series —Interruption.] I know they tried to shout down whistleblowers such as Julie Bailey, but we are not going to let that happen here. The Prime Minister asked Professor Keogh to conduct a series of “deep-dive” reviews of other hospitals with worrying mortality rates. No statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce.

Worryingly, in half those trusts, the Care Quality Commission—the regulator specifically responsible for patient safety and care—failed to spot any real cause for concern, rating them as “compliant” with basic standards. Each of those trusts has seen substantial changes to its management since 2010, including a new chief executive or chair at nine of the 14. However, although some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I am announcing today necessary.

This time, the process was thorough, expert-led and consisted of planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away, rather than waiting until the report was finished. We will be publishing all the reports today, alongside unedited video footage of the review panel’s conclusions—all of which I am placing in the Library. Today I will also set out the actions the Government are taking to deal with the issues raised. I would also like to record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.

Sir Bruce judged that none of the 14 hospitals is providing a consistently high quality of care to patients, with some very concerning examples of poor practice. He identified patterns across many of them, including professional and geographic isolation, failure to act on data or information that showed cause for concern, the absence of a culture of openness, a lack of willingness to learn from mistakes, a lack of ambition, and ineffectual governance and assurance processes. In some cases, trust boards were shockingly unaware of problems discovered by the review teams in their own hospitals. Today I can therefore announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care. In addition, the NHS Trust Development Authority and Monitor have today placed all 14 trusts on notice to fulfil all the recommendations made by the review. All will be inspected again within the next 12 months by the new chief inspector of hospitals, Professor Sir Mike Richards, who starts work today.

The hospitals in special measures are as follows: Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of “accepting sub-optimal care”; North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were closed immediately; Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break; and North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where both male and female patients were present. [Interruption.]

The list continues: United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 “never events” in just three years and the panel had serious concerns about the way “Do not attempt resuscitation” forms were being completed; Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, and of buzzers going unanswered and poor attention being paid to oral hygiene; East Lancashire Hospitals NHS Trust[Interruption.]

Photo of John Bercow John Bercow Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission

Order. We cannot have a running commentary on the statement as it is delivered. I remind the House that last Wednesday—when there were scenes of grave disorder manifested by Members on both sides of the House—the public reaction to that exceptionally bad behaviour was understandably negative. I appeal to right hon. and hon. Members on both sides of the Chamber to show courtesy and restraint. They can rely upon me to protect their interests—if they were here on time for the statement—to question the Secretary of State, but the statement must be heard.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The panel also highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends at East Lancashire Hospitals NHS

Trust. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.

The remaining hospitals in special measures are as follows: Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were seven “never events” in three years and concerns over infection control and overnight staffing levels; George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover, especially out of hours, a growing incidence of bed sores and too much unnecessary shifting of patients between wards; Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long accident and emergency waiting times; and Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.

For those 11 trusts, special measures mean that each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public. The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required. Each hospital will also be partnered with a high-performing NHS organisation to provide mentorship and guidance in improving the quality and safety of care.

Three of the 14 hospitals are not going into special measures. They are the Colchester Hospital University NHS Foundation Trust, the Dudley Group NHS Foundation Trust and the Blackpool Teaching Hospitals NHS Foundation Trust. Although there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.

This is a proportionate response in line with the findings of the review. Inevitably, there will be widespread public concern not just about these hospitals but about any NHS hospital, and some have chosen to criticise me for pointing out where there are failures in care, but the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out. The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved ones. Today’s review and the rigorous actions that we are taking demonstrate the progress this Government are making in response to the Francis report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate them in Government time.

The NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this, and we should remember that there continues to be much good care even in the hospitals reviewed today. Just as we cannot tolerate mediocre or weak leadership, we must not tolerate any attempts to cover up such failings. It is never acceptable for Government Ministers to put pressure on the NHS to suppress bad news, because in doing so they make it less likely that poor care will be tackled.

We have today begun a journey to change this culture. These 14 failing hospital trusts are not the end of the story. Where there are other examples of unacceptable care, we will find them and we will root them out. Under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems. There will be accountability, too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.

Hand in hand with greater accountability, there will be greater support. Drawing inspiration from education, where super-heads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary leaders such as David Dalton in Salford Royal and Dame Julie Moore of University hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.

At all times, this Government will stand up for hard-working NHS staff and patients who know that poor care and weak leadership have no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less. I commend this statement to the House.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health 1:23 pm, 16th July 2013

First, let me join the Secretary of State in thanking Sir Bruce Keogh and his team for this important review. Having worked closely with Sir Bruce, I know him well and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, we accept the findings of this report in full.

The statement we have just heard, however—the partisan statement—was not worthy of the excellent report that Sir Bruce has delivered today. The Health Secretary claimed at Health questions that this was a historical report, all about the past and the last Government. Well, I have got news for him: it is not. Trusts were identified on the basis of mortality data for 2011 and 2012. This report is about the right hon. Gentleman’s Government and failings that are happening now on this Government’s watch.

Anyone who supports the NHS must always be prepared to shine a spotlight on its failings, so it can face up to them and improve. In so doing, we must be fair to staff and the NHS as a whole. I am pleased to say that Sir Bruce is fair in his report. He says early in the report that the failings of the 14 hospitals must be put in context, stating that mortality in “all NHS hospitals” has been falling over the last decade by about 30%. He rightly reminds us of

“decades of neglect in the NHS in the 1980s and 1990s”,

and he speaks of the challenge facing the last Government in their early days. The key issue, he said,

“was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

The last Labour Government dealt with that issue; I am proud of it and we are proud of our record on the NHS.

The balanced picture presented in this report is not recognisable from the Government briefing appearing in the weekend newspapers. In fact, this report exposes one of the more cynical spin operations of recent times. Nowhere in this report does the claim of 13,000 avoidable deaths appear. Sir Bruce is clear, so let me quote him directly:

“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”,

but that is precisely what this Government chose to do in advance of this report. They made unfounded claims, which will have alarmed people in the areas served by the 14 hospitals, and they have questioned the integrity of the staff working in those hospitals in difficult circumstances—and all for their own self-serving political ends. That is simply unworthy of any responsible Government. On reading this review, the diversionary spin operation now makes sense because it reveals evidence of deterioration at all 14 hospitals on their watch.

Let me turn to one of Sir Bruce’s central findings—unsafe staffing. One of the report’s major concerns is that trusts have allowed staffing levels to drop to dangerously low levels. It says:

“When the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas.”

Already, the review team has had to intervene on staffing levels in three trusts to protect patient safety.

The Secretary of State claimed in his comments that the Care Quality Commission had failed to spot any problems. Working with the CQC during the last Government, I left in place warnings about five of these hospitals. The Secretary of State claims that we were covering up, so let me answer on the question of Ministers’ integrity and cite the Francis report, which said that there was no evidence that any Minister received or ignored advice that would have led to safe outcomes. Let me quote to him from a letter sent by Baroness Young to the Prime Minister yesterday:

“CQC was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures.”

It is outrageous for the Secretary of State to come to the House today and repeat those concerns without a shred of evidence to back them up.

Five of the trusts examined by Keogh had warnings in place, and it is shocking that they have been allowed to cut staff to unsafe levels on this Government’s watch. Overall, seven of the trusts in the review have cut front-line staff by a shocking 1,117. The great sadness is that it appears Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified “dangerous cuts” to the front line as a primary cause of care failures. Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Is it not the case that the Secretary of State can no longer ignore these authoritative calls, and will he take urgent action on safe staffing levels in these 14 trusts and across the NHS? Will he accept that the loss of over 4,000 nursing jobs that has now been laid bare under this Government is a monumental mistake, while £3 billion has been siphoned out of the NHS front line to pay for reorganisation that nobody wanted and nobody voted for?

Let me turn to A and E performance, the barometer of the health service and a wider indication of problems across hospitals. The report highlights major failings in A and E at many of the trusts and we know that the NHS has just come through the worst winter for a decade. At the end of last year, all 14 trusts were in breach of the Government’s A and E target—when, under the previous Government, all 14 were meeting the A and E target.

Sir Bruce is clear that urgent action is needed to improve A and E. Let me quote the report:

“We have established that one of the primary causes of high mortality in these hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients…All trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellation of operations due to bed shortages and difficulty meeting waiting time targets.”

Will the Secretary of State now take immediate action, working with the whole health economy in these 14 areas, to bring each trust back up to the national standards on A and E that his Government have set? Will he accept that it is not fair to these hospitals to blame them alone, as the devastating cuts to social care are a major driver of pressure in hospitals?

Finally, on what happens next, the simple truth is that people watching will want solutions rather than point scoring. Surely the right response to the Keogh review is now to accept the Francis recommendations in full, particularly on minimum staffing. A duty of candour on individuals will help bring the culture change we need at local level and, of course, we need to see the regulation of health care assistants. Will the Secretary of State work with us now on early implementation of the Francis recommendations? He spoke earlier of a new era of transparency. If he means what he says, will he now publish the NHS risk register? For all we know, it might well have predicted some of the failings we are reading about today.

It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What matters is how the NHS responds. Rather than pulling down the shutters and pushing people away, it is right that we should hold a mirror up to the NHS so that it can act on its failings. We must also be fair to people working in the NHS by ensuring that an accurate picture is presented. Sir Bruce has had to take the extraordinary step already of distancing himself from the Government briefings that appeared at the weekend. I hope the Government will learn a painful lesson from this: you should not play politics with people’s lives and you should not play politics with the NHS, on which all people depend.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Mr Speaker, it is hard for a serving Health Secretary to admit that things can go wrong in the NHS, but we know today that it is even harder for a former Health Secretary. We have heard nothing but shameful denial. The right hon. Gentleman—[Interruption.]

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The right hon. Gentleman talked about being partisan and party political. It is not party political to highlight poor care; it is doing the right thing for patients.

Let us look at what independent people have said about Labour’s time in office. Roger Davidson, the former head of media at the CQC, said that

“there were conversations between the CQC and Ministers to the effect that the CQC would not cause any trouble…The message that ‘we don’t want bad news’ infected the whole organisation”.

Professor Brian Jarman—[Interruption.] I think Opposition Members might want to listen to this, because it is what independent people are saying. Professor Jarman, who invented hospital standardised mortality indices, said that

“the problem was ministerial pressure, even from Number 10.”

This is most damaging: the right hon. Gentleman talked about what Barbara Young, Labour peer and head of the CQC, said under pressure from the Labour Whips, but what did she say under oath to the Francis inquiry? She said that

“the government hated the idea…the regulator would criticise it… We were under more pressure, I think, when Andy Burnham became minister, from the politics.”

That is what a Labour peer said. These people are not Government supporters—at least, not of this Government —but were trying to do their job in exposing poor care and the right hon. Gentleman stopped them.

The right hon. Gentleman talks of spin, but I will tell him who had to fight hardest against spin: the whistleblowers he tried to shut up. What do they say? James Titcombe, who tragically lost his son at Morecambe bay, tweeted that

“you made big mistakes Andy, it’s time you admitted it.”

Julie Bailey, who lost her mother at Mid Staffs, said that Labour crushed the culture of care from the NHS. [Interruption.] Deb Hazeldine, from Mid Staffs, who lost a relative, said that the shadow Secretary of State was trying to “defend the indefensible”—[Interruption.]

Photo of John Bercow John Bercow Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission

Order. It is very difficult to imagine how anyone can hear these exchanges. The content of questions and answers is to be determined by Members, but I gently remind the House of the need for good order and that this is not a debate. There will be debates, but this is not a debate but a statement on which there is questioning, to which there is then a ministerial answer. This is not an opportunity for general speechifying but for responses to specific questions made with economy so that I can accommodate all interested colleagues.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Thank you, Mr Speaker. I would have hoped that the Opposition would want to listen more respectfully to what whistleblowers said about their attempts to expose poor care.

Let me respond to what the right hon. Gentleman says. He says that Labour tackled the problems, but the evidence shows the opposite. We talked about Tameside earlier, but what about Basildon? There were high death rates for nine years under Labour—in every year since 2001. Half the staff said they would not want their own friends and family treated there. Ministers received 237 letters between 2005 and 2010, yet what did the CQC do? It rated the hospital as “good” and within four weeks Ministers were shamed into launching an investigation into high mortality rates—[Interruption.]

Photo of John Bercow John Bercow Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission

Order. I have tried to explain the position calmly—[Interruption.] Order. I shall do so once more. I think the Secretary of State will appreciate that he has been asked questions about present arrangements to which we need pithy replies, not a lengthy statement about events of the past that happened before he had responsibility. We cannot have that. If that is what he is planning to read out, we will simply move on. A brief conclusion to his answer is now required and sought by the House.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

So, Mr Speaker, let me briefly take the final two points raised by the right hon. Gentleman. He says the trusts have got worse since 2010, but what does he do when I criticise the lack of progress—[Interruption.]

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Thank you, Mr Speaker.

What does the right hon. Gentleman do when I criticise the lack of rapid progress in tackling failure in our hospitals? He criticises me for making an unbelievable statement and states that there are no coasting hospitals, but today proves that he is wrong. What is unbelievable is his total refusal to admit that it is not just a question of coasting hospitals, but a Labour party that has coasted for too long on its reputation on the NHS.

Finally, the right hon. Gentleman says that we are trying—[Interruption.] This is difficult for Labour Members to hear, so let us get to the point. He says that we are trying to run down the NHS. Let me say this: if we did not believe in the NHS, we would not be tackling these problems. The best way to support the NHS is not to ignore poor care, not to muzzle the CQC, not to ignore requests for public inquiries and not to ignore warnings constantly. If founding the NHS is considered Labour’s proudest achievement, today is its darkest moment as a Labour Government are exposed as caring more about their own reputation than about our most vulnerable citizens in the NHS—[Interruption.]

Several hon. Members:

rose—

Photo of John Bercow John Bercow Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission

Order. I remind the House of the long-established and generally adhered-to convention that Members who were not present at the start of a statement do not rise to question the relevant Minister. That has long been regarded as a discourtesy, and it should not happen. I have a list of Members who arrived late, but I hope that they will not render it necessary for me to draw attention to the fact. I ask those who arrived late, in all courtesy, not to rise to their feet.

We will now make progress as expeditiously as we can, led by the Chair of the Health Committee.

Photo of Stephen Dorrell Stephen Dorrell Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

Those who want to make the case for change in an organisation—and, after the Francis review, who can doubt the need for change in parts of the national health service?—must first demonstrate the need for change. Does this review not build on the distinguished record of both Bruce Keogh and Sir Brian Jarman in demonstrating the need for change in parts of our national health service?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My right hon. Friend speaks very wisely. As I know he agrees, identifying problems publicly is incredibly difficult, but the way to ensure that those problems are dealt with is to be totally honest and transparent about them in the knowledge that they will be sorted out as a result, and that is what is happening today.

Photo of Alan Johnson Alan Johnson Labour, Kingston upon Hull West and Hessle

Thankfully, the quality of Sir Bruce Keogh’s report is vastly superior to that of the statement that we heard from the Secretary of State. Is it not the case that Sir Bruce Keogh—[Interruption.]

Photo of John Bercow John Bercow Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission

Order. I am very concerned about the fact that someone shouted something, and I think I heard a word that was unparliamentary. I did not see an individual who was responsible, and I do not know who was responsible, but I simply say to the House—[Interruption.] Order. It is no good people burbling on about whistleblowers from a sedentary position. Let us lower the temperature, and have orderly exchanges. [Interruption.] Order. I remind the House that I called Alan Johnson to ask a question. Let us do him the courtesy of hearing the conclusion of that question.

Photo of Alan Johnson Alan Johnson Labour, Kingston upon Hull West and Hessle

Is it not the case that Sir Bruce may have given us a blueprint for better regulation, provided that the Secretary of State faces up to his responsibility and ends the tawdry and squalid attempts by his party to denigrate his predecessors?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I am sure that the right hon. Gentleman, who is one of those predecessors, would accept at a quieter moment outside the Chamber that one of the biggest mistakes made during his time as Secretary of State—or at least it was initiated then—was the appalling change that was made to the regulation of hospitals. The CQC was stripped of expert inspectors, and hospitals began to be inspected by generalists. The same group of people would inspect a slimming clinic, a dental practice, a GP’s surgery, and a major London teaching hospital. That very significant mistake lies at the heart of the reason why the CQC approved and certified so many failing hospitals.

I am happy to work with the right hon. Gentleman, and to say that honest mistakes were made and we will put them right, but today there must be honesty about what those mistakes were.

Photo of Dame Cheryl Gillan Dame Cheryl Gillan Conservative, Chesham and Amersham

Patients and their families outside this place will join me in congratulating the Secretary of State on his brave decision not to sweep NHS failures under the carpet.

You and I know, Mr. Speaker, that Buckinghamshire contains many areas of health care that are of high quality, but the report identifies some failings, one of which is the quality of out-of-hours and weekend nursing and medical cover for acute medical patients. That is clearly linked to difficulties relating to the recruitment, retention and availability of competent clinicians and nurses. What more can the Department do to help our trusts improve out-of-hours provision and, in particular, the quality of temporary staff, so that those problems can be eliminated?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My right hon. Friend is right. Serious problems were identified in Buckinghamshire relating to out-of-hours care and also to dementia patients, who themselves often need help out of hours. I raised the difficult issue of the GP contract because, in order to solve such problems, we need more joined-up care in the community. The Chancellor has announced an additional £2.8 billion for joint commissioning arrangements between local authorities and health care bodies, and I think that the combination of those two measures will secure a vastly improved out-of-hours service for my right hon. Friend’s constituents.

Photo of Jack Straw Jack Straw Labour, Blackburn

I welcome the Keogh report and the action that the Secretary of State has announced, which, although it will be uncomfortable for my local health trust, I believe to be necessary. However, I hope that, on reflection, the right hon. Gentleman will realise that the comments that he has made demean his office. I sat in the Cabinet with my right hon. Friends the Members for Leigh (Andy Burnham) and for Kingston upon Hull West and Hessle (Alan Johnson). I saw how anxious they were to root out inefficiency and failings, and to cover nothing up, and I think it inappropriate for the Secretary of State to suggest that he and his party have a monopoly when it comes to concern about the transparency and effectiveness of the health service.

Last Thursday, the Secretary of State commended Royal Blackburn hospital for its vascular services and accepted the excellence of many of its staff. While we are navigating through this difficult period, is it not crucially important for us to echo the Keogh report and point out that, overwhelmingly, hospitals in areas such as mine employ high-quality staff who require better leadership?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Improving leadership is vital throughout the NHS. All Governments must take responsibility for what happens on their watch, and I have taken responsibility today for those 14 hospitals and all their serious problems. The right hon. Gentleman should accept that between 2005 and 2010 his Government received 142 letters about his hospital which they did nothing about, and introduced a regulatory system that did not expose poor care and ensure that it was addressed.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

I welcome Sir Bruce Keogh’s important report. However, although I admire my right hon. Friend, I totally dissociate myself from his ill-judged attempt to drag this important issue into the gutter of partisan politics and petty point-scoring. I expect better of him than that.

It is clear from annex A of the report that in all but one of the 14 hospitals, problems relating to staffing levels and the staff mix need to be addressed, and ambition 6 recommends action to address them. As my right hon. Friend knows, I campaign on this issue. What will the Government do to ensure that staffing levels are adequate in our acute hospitals?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Tackling failure in our NHS is not an easy path to take, but it is the right thing to do for patients. If my hon. Friend believes that all the care problems in the NHS started in 2010, I think he is the only Member who does. [Interruption.] Opposition Members must bear their share of the responsibility for the failures that they did not sort out. Staffing is indeed a problem that needs to be sorted out in many trusts, which is why we commissioned the review and why we are sending in turnaround teams to do just that.

Photo of Joan Ruddock Joan Ruddock Labour, Lewisham, Deptford

The Secretary of State has made an appalling attempt to smear my right hon. Friend Andy Burnham. Will he now acknowledge that in 2009, my right hon. Friend sought a review of all the hospitals with high mortality rates, that 21 were registered with conditions, and that five had warnings placed on them, which he and he his predecessor inherited? Will he tell the House what he and his predecessor did in respect of those hospitals in 2010, 2011 and 2012?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

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

Photo of Bill Cash Bill Cash Chair, European Scrutiny Committee, Chair, European Scrutiny Committee

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

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

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

Photo of Tony Cunningham Tony Cunningham Shadow Minister (International Development)

If the teams going into Cumbria recommend increased staffing and resources, will the Secretary of State fund that?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

If the issues are around staffing, we will sort those out. If the issues are around leadership, we will sort those out. If the issues are around clinical practice, we will sort that out. My commitment to the House is that we will do what it takes to sort out these failing hospitals.

Photo of Phillip Lee Phillip Lee Conservative, Bracknell

In 2006 the then Labour Government purchased 49% of Dr Foster, the intelligence unit from which a lot of these mortality data are emanating. Does the Secretary of State agree that for Secretaries of State from that point onwards to be claiming they were unaware of the data seems a bit rich?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

There were repeatedly high mortality rates in all these 14 hospitals, and it took the public inquiry that Labour did not want to demonstrate to the world just how important hospital standardised mortality ratios are. They are the smoke alarm that was ignored in the case of Mid Staffs, and which could have led to the prevention of thousands of tragedies if we had taken action earlier. That is why we immediately insisted on this review by Sir Bruce.

Photo of Grahame Morris Grahame Morris Labour, Easington

I think there is widespread respect for Sir Bruce Keogh and his report and I certainly welcome it, but it is a cynical move by the Secretary of State to try to besmirch the reputation of my right hon. Friend Andy Burnham. May I point out that on this Government’s watch clinical negligence claims are up 50%, A and E waits are at a nine-year high and “never events” have tripled? What is the Secretary of State going to do about them?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We spend more than £1 billion every year on clinical negligence because the hon. Gentleman’s Government changed the rules so that trusts suffer no financial penalty when they have to pay a clinical negligence claim. That is something we really need to look at, because it is removing one of the biggest possible incentives for trusts to treat people safely.

Photo of Mark Reckless Mark Reckless Conservative, Rochester and Strood

Is the Secretary of State aware that in Medway we were left with just three consultants to share cover of A and E, but we have now increased the number to six, and it will soon rise to eight?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

These are precisely the problems that this review is designed to root out. There were problems with long A and E waits as well as with inappropriate medical interventions and poor communication with patients, but I hope my hon. Friend’s constituents will be reassured by the transparency of what is happening today, and the fact that I am making this Government accountable for sorting out those sorts of problems.

Photo of Chris Bryant Chris Bryant Shadow Minister (Home Affairs)

I suspect that in a quieter moment the Secretary of State will not think this statement was his proudest moment. [Interruption.] Well, it seems that he used to be run by Coulson and now he is run by Crosby.

Most voters will be more interested in the future and how we can make sure that people’s lives are protected, so what does the Secretary of State have to say about the fact that fewer people are coming from other countries to work in the NHS? Because of the Government’s immigration policy, there is a real danger that we will have a significant problem in A and E recruitment across the country.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I struggle to find the link between that question and Sir Bruce Keogh’s report on the 14 hospitals, but as the hon. Gentleman has asked about A and E, and as he is trying to take the moral high ground, perhaps he would explain why he has not been standing up in this House campaigning against Labour’s abysmal record, as it has missed its A and E targets in Wales since 2009.

Photo of Rehman Chishti Rehman Chishti Conservative, Gillingham and Rainham

In 2005 and 2006 Medway Maritime hospital had the seventh worst mortality rate in the country, yet nothing was done. May I thank the Secretary of State for the actions he has put forward today, which will help improve the quality of care for my constituents and people from further afield?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is right. There were high mortality rates in his hospital in six of the nine years they were measured under the last Labour Government, and there were problems with A and E and with inappropriate medical interventions. He can say to his constituents today that the Government have identified the problem and have been transparent about it, and we will be accountable for sorting it out.

Photo of Kevin Barron Kevin Barron Chair, Committee of Privileges, Chair, Committee on Standards, Chair, Committee of Privileges, Chair, Committee on Standards

How many health professional regulatory bodies has the Secretary of State met since the publication of the Francis report?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I think I have met most of them, but I have certainly met the General Medical Council and the Nursing and Midwifery Council, and I have talked to them about the reasons they are finding it difficult to remove doctors and nurses from their lists when there are questions about their poor performance.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

To complete the Medway Maritime hat trick, may I say I am very disappointed to hear from the Secretary of State that the hospital has gone into special measures? I have been assured that Sir Bruce Keogh’s recommendations are already being implemented, but will the Secretary of State say in what time frame he, and more importantly my constituents, should expect to see significant improvements at the Maritime?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We want these things to happen as quickly as possible, but all the hospitals Sir Bruce reviewed will be looked at again within the next year by the chief inspector of hospitals, Professor Sir Mike Richards, who starts work today, so we will be able to measure whether progress has been as swift as my hon. Friend and I would like.

Photo of Helen Jones Helen Jones Shadow Minister (Communities and Local Government)

May I ask the Secretary of State to actually discharge one of the responsibilities of his office by answering a simple question? If he believes that managers should not be able to get another post if they fail, why was there a plan to transfer the chief nurse from the failed Morecambe Bay NHS Trust on secondment to Warrington and Halton on the Secretary of State’s watch, stopped only when my hon. Friend Derek Twigg and I found out about it? Did he or his Ministers know about this plan, and if not, why not?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is exactly the reason why we are introducing measures to make sure—[Interruption.] Well, the Francis report was introduced to this House on 6 February, and we have said we will change legislation this year. We have already appointed a chief inspector of hospitals. I do not think we could go much faster. The trouble for the Labour party is not that we are going too slowly but that we are going too fast and exposing all sorts of problems which it wishes did not happen.

Photo of Andrew Griffiths Andrew Griffiths Conservative, Burton

I thank the Secretary of State for shining a light on to the health care provided by Queen’s hospital in Burton. Although Queen’s has a lower unexpected death rate than other hospitals, any unnecessary death is a tragedy for the family concerned. Given that since 2005 Queen’s hospital had a higher mortality rate than Stafford hospital, does he understand the anger of my constituents who have seen their loved ones die unnecessarily and these concerns ignored by Labour?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend’s hospital had excess mortality rates for five of the nine years leading up to 2010 and not enough action was taken, and that is what today is all about. I hope that what his constituents will take from today is that this Government are committed to turning around failing hospitals and putting in place the right leadership, and the reassurance that when their loved ones go to Queen’s hospital or anywhere else in the country, they can get the kind of care they would want for themselves.

Photo of Gisela Stuart Gisela Stuart Labour, Birmingham, Edgbaston

May I say to the Secretary of State that there is a tone and a language that we should choose to employ for candid conversations about failure and it saddens me that he did not find that language today, because it will not do us any good? The Francis report recommended a duty of candour. Will he update the House as to just how much progress he has made on that?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Yes, I can. We have accepted the recommendation that there should be a duty of candour on the boards of hospitals, with criminal sanctions if they fail to tell members of the public that they or their loved ones have been harmed by the hospital, and if they fail to tell the system that those incidents have happened. We have commissioned a review of safety by Sir Don Berwick, one of the greatest experts in the world, and we shall ask him whether we should extend that duty of candour to below board level. We shall wait to hear what he says. We understand the reasons why people might want to do that, but we are also aware that others have expressed the concern that it might destroy an atmosphere of trust in a hospital if people were worried about criminal consequences if they did not talk about any failures they saw in their daily work.

Photo of Margot James Margot James Conservative, Stourbridge

I warmly welcome my right hon. Friend’s break with the culture of cover-up that has been so prevalent in the past. I reject absolutely the shadow Health Secretary’s claim that the Dudley Group NHS Foundation Trust’s performance has deteriorated since 2010—

[

Interruption.

]

Photo of John Bercow John Bercow Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission

Order. The hon. Lady is asking a question, but I have distinctly heard Members—in some cases identifiable Members—trying to shout her down. That should not happen on either side of the House. If she wishes to continue with her question, she may do so.

Photo of Margot James Margot James Conservative, Stourbridge

Thank you, Mr Speaker.

I reject the shadow Health Secretary’s claim. The new leadership that was appointed to the trust in 2009 found deep-seated problems there. Does my right hon. Friend the Secretary of State welcome, as I do, the positive notes in Sir Bruce Keogh’s report about that new leadership’s abilities, and Sir Bruce’s finding that the overall work force at our trust are

“committed, loyal, passionate, caring and motivated”?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I welcome that, and I am delighted that my hon. Friend’s trust was not one of the ones that it was necessary to put into special measures. We have learnt a lesson from the successful way in which the schools system is regulated. Ofsted distinguishes between failing schools that have in place good management who are able to turn the school round and those where a change of leadership is required, and I am pleased that the report found that Dudley had the right leadership in place.

Photo of Gloria De Piero Gloria De Piero Shadow Minister (Home Affairs)

I welcome the report and I hope that the new chief executive at King’s Mill hospital in my constituency will provide the leadership that has been lacking in recent years. He assures me that he will implement all the report’s recommendations. The report mentions

“significant concerns around staffing levels at…King’s Mill Hospital”.

The trust has lost more than 200 nurses since 2010. Can we have them back?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Staffing levels are indeed one of the issues that contribute to poor care, if we get them wrong. That is why we are committed to implementing the Francis recommendations on safe staffing levels, and why, having protected and increased the NHS budget—contrary to what the shadow Secretary of State wanted—we now have 6,000 additional doctors working in the NHS. [Interruption.] In these individual cases, if staffing levels are the issue, they will be addressed.

Photo of John Baron John Baron Conservative, Basildon and Billericay

The Secretary of State has been absolutely right to highlight and pursue past failures for the benefit of future patients. That includes investigating why the regulatory system seems to have failed in these cases. Does he agree, however, that we must not allow the report to overshadow much of the good work that is being done in our hospitals, including Basildon hospital which now has new management and is instigating changes?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I agree with that. One reason why it is so important to reform the regulatory structures that we inherited is that they tried to identify only poor care—not terribly successfully—when we need a system that identifies outstanding care as well. We need such a system for the benefit of the general reputation of the NHS and the morale of the service. We also need one so that a failing hospital can have an organisation on which it can model itself, just as a failing school can model itself on a school that has received an outstanding Ofsted report. That provides a solution to the problem: we identify a problem transparently and we sort it out.

Photo of Chris Williamson Chris Williamson Shadow Minister (Communities and Local Government)

The Secretary of State said that he was proud of the NHS, yet he and his Ministers have supported a top-down reorganisation of the national health service that will lead to 49% privatisation and cut 4,000 nurses. We know from the Francis report that staffing levels are key to the whole agenda, and the Secretary of State has just said he acknowledges that, so will he reinstate the 4,000 nurses he has cut from the NHS?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Perhaps the hon. Gentleman would like to acknowledge that more money has gone to the front line as a result of the reorganisation that this Government have introduced. We have 8,000 more clinical staff now than when the Labour Government were in office.

Photo of Steven Baker Steven Baker Conservative, Wycombe

Walter Coles died because he was forgotten. Edward Maitland died because he was fed solid food. I could name others; those are just two of the patients who have died unnecessarily. And yet high mortality rates made it on to the board’s agenda in Buckinghamshire only because of a trigger relating to concern for reputational risk. The board had no robust risk management practices in place, and there were no plans to introduce any. Furthermore, certain key elements relating to changes in urgent care were missing. In setting out to champion patients, will my right hon. Friend set out how it will be possible to remove an entire board, or any members of a board who are not performing well?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Absolutely. I congratulate my hon. Friend on his extraordinary campaigning on behalf of his constituents. It is very difficult for a local Member to take on his own hospital when he finds failings, but he does it with great bravery. Yes, we need to ensure that the way we judge hospitals is not just about meeting waiting time and A and E targets, important though they are; it must also be about safety, about compassionate care and about governance. Other things matter as well. That is what we are changing.

Photo of Jack Dromey Jack Dromey Shadow Minister (Housing)

In a new low for British politics, the Secretary of State today descended into the gutter. How can he begin to blame the last Government for the deterioration at the 14 hospitals concerned, which took place under this Government, especially as the Government were warned about unacceptable standards in five of them?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The low in British politics is that it took so long for a Government to be honest about failings in the NHS. Many of those hospitals have a culture that entrenched failure for years and years under the last Labour Government, yet Labour Members refuse to accept that even now. What does that say to the public about whether they can be trusted with the future of our NHS?

Photo of Martin Vickers Martin Vickers Conservative, Cleethorpes

I welcome the robust and determined approach that my right hon. Friend is taking. It is right that the mistakes of the past should be thoroughly investigated, but my constituents—some of whom are waiting to go into Grimsby and Scunthorpe hospitals—need an assurance that action will be taken to remedy the situation immediately. There are many dedicated staff in our area, but recruitment has always been a problem in northern Lincolnshire. Will my right hon. Friend assure me that if additional support is needed to recruit the best clinicians and managers, it will be made available?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We will quite simply do what it takes to ensure that we implement the recommendations of the Keogh review for north Lincolnshire hospitals. We owe my hon. Friend’s constituents nothing less. The first step is to be honest about the problems. The big difference between the two sides of the House is illustrated by the fact that we will restore morale not by pretending that the problems do not exist but by being honest about them and confronting them. That is what we will do in my hon. Friend’s constituency.

Photo of Sarah Champion Sarah Champion Labour, Rotherham

I should like to start by offering my deepest sympathy to the patients and families. We are talking about mortality statistics, but these are actually loved ones who have been lost. For the second time today, I ask the Secretary of State whether he will accept, adopt and implement the recommendations in the Francis report.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

And for the second time, I say yes.

Photo of Tony Baldry Tony Baldry The Second Church Estates Commissioner

Professor Brian Jarman observed that, until recently, the Department of Health seemed to be a “denial machine” and that there was suppression and spin. Will the Secretary of State and the whole House at least agree that there is no room for denial, suppression or spin in the NHS, and that what we need for the future are total transparency, accountability and a Care Quality Commission that performs properly and professionally?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend speaks wisely, because the first step towards sorting out these problems is to have a system that Ministers cannot interfere with so that when there is failure, regulators are able to speak out without any political pressure—without any Ministers leaning on them in the run-up to elections—in the interests of patients. That is why we are completely changing the CQC. We are introducing a chief inspector of hospitals, who will be the nation’s whistleblower and who will have the independence and freedom that the old CQC never had. I hope that will help the public feel more confident that where there are problems they are properly tackled and not swept under the carpet.

Photo of Alex Cunningham Alex Cunningham Labour, Stockton North

Several times the Secretary of State has admitted that staffing cut drastically on his watch is a major factor in deteriorating care in the NHS—an NHS that has been in the charge of the Conservative party for more than three years. What is he going to do about restoring staffing levels?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Clinical staff numbers have gone up by 8,000 since 2010: there are 6,000 more doctors, 1,000 more midwives and 1,000 more health visitors. The numbers have gone up since 2010. If we followed the shadow Secretary of State’s advice and cut the NHS budget from its current levels, that would not be possible.

Photo of Marcus Jones Marcus Jones Conservative, Nuneaton

I am pleased that the Secretary of State has sought to take tough decisions to bring more openness and transparency to our NHS and not keep sweeping things under the carpet. Improving quality for patients is the immediate priority, and I support him in the decisive action he has taken, but will he also now seek to establish a sustainable future for the George Eliot hospital, which has suffered from a great deal of uncertainty since 2006?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I absolutely intend to do that. As my hon. Friend knows, I have been to the George Eliot hospital, working part of a shift in its accident and emergency department. I thought the staff there were working extremely hard, under great pressure. I noticed that the hospital did not have the systems in place that others have; I believe that hospital had 16 IT systems, which meant that if someone in the A and E department needed a blood test, all the details would have to be re-entered on a different system. That takes up a lot of clinical time, so making changes in these areas can make a big difference. But I do think it is important, as we expose these problems, that we recognise that even at the 14 hospitals mentioned today good care is being provided every day and the staff in those hospitals are working very hard. We need to back them, and the best way of doing so is to give them confidence that we are going to turn around their hospital.

Photo of Andrew Miller Andrew Miller Chair, Science and Technology Committee (Commons), Chair, Science and Technology Committee (Commons)

Management systems that are run on a blame culture inevitably create cover-ups and lead to people disguising the facts. Will the Secretary of State now show some leadership by trying to eradicate that from the health service? Will he take the advice Professor Ashton gave on Radio 4 this morning, because he expressed a firm way forward for the NHS? Will the Secretary of State stop playing these silly political games and follow Professor Ashton’s advice?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

It is not playing silly political games to expose poor care; it is doing my duty as Health Secretary, and that is what I will continue to do. Improving systems, such as making sure there is safe staffing, is very important. It is ridiculous in this day and age that someone can be admitted to A and E but that department cannot access their GP record, and cannot see whether they are a diabetic or whether they have mild dementia. Those are things we are determined to sort out.

Photo of Bob Russell Bob Russell Liberal Democrat, Colchester

On 6 February, the Prime Minister asked Professor Sir Bruce Keogh to review the quality of hospital care. Although Colchester is only one hour from London, Sir Bruce did not make a single visit in the five months that elapsed. Although, obviously, I welcome the Secretary of State’s observation today that for Colchester general hospital this is more of a green light than a red light, will he do what Sir Bruce did not do and visit the hospital, so that he can, in the words of the panel, meet a large number of “committed and enthusiastic” staff?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I would be delighted to do that. I try to visit somewhere on the front line in the NHS every week, making sure I do not just visit the best places; I visit places that have problems and places like Colchester hospital which are improving—I am delighted that Sir Bruce’s report recognised that.

Photo of Emily Thornberry Emily Thornberry Shadow Attorney General

The Secretary of State began his statement with an alarming story about patients being left unmonitored on trolleys—I understand that took place at Tameside hospital. Does he agree that there may be a connection between that and the fact that there are 128 fewer nurses, midwives and health visitors in that hospital than there were in 2010? Given that the previous Government flagged up that hospital as one of particular concern, was he watching it to make sure that there were no cuts in nursing staff there?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

As I have said many times, where there is not safe staffing we need to put that right. As I have also said, there are 8,000 more front-line staff under this Government than there were when the hon. Lady’s Government were in power. But those are not the only issues; we also need to address issues of leadership, of systems, which we talked about, and of clinical effectiveness. We need to sort out all those. On staffing numbers, I would just point out that plenty of hospitals under equivalent financial pressures are managing to deliver outstanding care, so a lot of this is about getting the right leadership in place at a board level.

Photo of Andrew Bridgen Andrew Bridgen Conservative, North West Leicestershire

On 1 July, just over two weeks ago, my aunt died unexpectedly and alone at Queen’s hospital, Burton. The Keogh review has now shown that hospital to have had a higher mortality rate than Stafford since at least 2005. Will my right hon. Friend pledge to work tirelessly to heal our NHS, so that my constituents, my friends and my relatives do not continue to die unnecessarily because of the failed policies of the previous Labour Government? [Interruption.]

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

This is the problem. [Interruption.] This is the denial we are getting from the Labour party; it is denying any responsibility for these deep-seated problems in some of our hospitals. As Health Secretary, I intend to do exactly as my hon. Friend describes. In order to try to measure the progress we are making, we will this year for the first time be asking every NHS in-patient whether they would recommend the quality of care that they received to a friend or a member of their family, because in the end that is what this is all about.

Photo of Derek Twigg Derek Twigg Labour, Halton

In May 2010, had mortality rates been falling in NHS hospitals?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

According to Professor Jarman on the radio this morning, the answer is that it has been falling slightly.

Photo of Bernard Jenkin Bernard Jenkin Chair, Public Administration Committee

I welcome the fact that Colchester general hospital is not being put in special measures. That expresses Monitor’s confidence in the current leadership of the hospital, which is already implementing improvements in the areas that it told the Keogh report about, which are reported to be the matters of concern. I also welcome my right hon. Friend’s emphasis on leadership, and openness and trust of leadership, but does he accept what we are finding in the Public Administration Committee’s inquiry into complaints handling in public services that that lack of trust and openness is found not just at trust level, but goes right up the command chain of the health service and has historically existed in the Department of Health? How will he challenge that culture and define the right kind of leadership that should be taught by the leadership academy?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend makes a very important point. The simple way we can change that culture, which will not be easy and will not happen immediately, is by making sure that where there is failure, there is someone who is independent and able to speak up about that failure without fear or favour—someone to be the nation’s whistleblower-in-chief. That is what we must have with the new chief inspector of hospitals, modelled on the chief inspector of schools and how well the whole Ofsted regulation system has worked. That has to be the first step; there must be no hiding place when there is failure. From there, we will have the pressure on the whole system, right the way up to Ministers, to make sure that failure is sorted out.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons)

Sir Bruce Keogh warns us in his report about the very reaction we have seen today, which is in danger of shaming this House by focusing on politics instead of people. He wrote in his first few paragraphs that

“this is not a time for hasty reactions and recriminations”.

I read those words at five past 8 this morning when the Department of Health finally opened up to allow Members of Parliament to read what was there. Will the Secretary of State assure me and my constituents, who use Scunthorpe general hospital, that he will work to support people and put people before politics, because this afternoon he has put politics before people?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is exactly what I am doing; the best hope we can give to the hon. Gentleman’s constituents is to say that we are putting them first by being honest about the problems and by tackling the mediocrity that has been a feature of too many hospitals for too long.

Photo of Jackie Doyle-Price Jackie Doyle-Price Conservative, Thurrock

Bereaved families in Thurrock have had their pain compounded by how the Basildon and Thurrock trust has investigated complaints and incidents. Does my right hon. Friend agree that the way in which hospitals investigate such incidents is an important aspect of the transparency and accountability agenda?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

It is, and this year we will be introducing in law a duty of candour that will make it a criminal offence for boards not to be honest, not only with families if patients have been harmed, but with the system, which is extremely important. Salford Royal hospital has one of the most successful safety records in the country, and it has achieved that by creating an atmosphere of trust so that front-line staff are not afraid to speak out about the problems that they encounter, however junior they are. It takes outstanding leadership to get that right, and part of the turning point that we require today is an understanding of what is involved in such leadership, which we need in many more places.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights)

High mortality rates are unacceptable and their effect on people’s confidence in, and satisfaction with, the NHS is a problem. We in Northern Ireland are fortunate that there have not been such disclosures, but it is important that lessons can be learned. Does the Secretary of State intend to share the data and findings with regions of the United Kingdom and the devolved Administration in the Northern Ireland Assembly?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

When there are excess mortality rates, there is some controversy about exactly how many avoidable deaths they correspond to, which is why Professor Keogh has asked Professor Nick Black and Lord Darzi to carry out a further study to try better to understand the link between excess mortality and avoidable deaths. We will be happy to share that information with the devolved Administrations.

Several hon. Members:

rose—

Photo of John Stevenson John Stevenson Conservative, Carlisle

I welcome the Keogh report. Patients should come first and patient care should be at the centre of our health service. Over the past 10 years, sadly, there has been a clear lack of leadership and management at North Cumbria University Hospitals NHS Trust, so I am not surprised by the report. However, there is a possible solution to improve health care in north Cumbria: the acquisition of the hospitals by Northumbria Healthcare NHS Foundation Trust. Will the Secretary of State work with me, the regulators and Northumbria to ensure that the acquisition proceeds as quickly as possible so that the people of Cumbria and Carlisle get the best possible health care?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I very much hope that that acquisition can proceed and I agree with my hon. Friend that it is the way forward. Although we have to ensure that that happens properly, Northumbria can give North Cumbria the leadership that it badly needs, so the process would be positive.

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South

Since the publication of the Francis report, it seems that we have been going round and round the question of safe staffing levels, which I have raised several times. Ratios of two nurses to 29 patients, or worse, have been reported to me—I do not think that they are uncommon—and the CQC tells us that one in 10 hospitals has unsafe staffing levels. It must be accepted that the number of nurses has reached unsafe levels in these 14 hospitals and many parts of the country. The Secretary of State cited Salford Royal hospital, but will he act now to ensure that all wards in all hospitals publicise their staffing ratios, because I would not want a relative on a ward with a ratio of 2:29?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The right ratio of patients to nurses depends on the type of patients in a ward, because different wards have different requirements. Salford Royal has a good model through which it ensures that it has the right number of nurses. As I said to Sarah Champion, I accept what Francis says about safe staffing, but he did not recommend the Labour party’s policy of minimum mandated national staffing levels. I am following the recommendation of the Francis report, which I think is the right way forward.

Photo of Andrew Bingham Andrew Bingham Conservative, High Peak

My constituents in Glossop use Tameside hospital. For too long, people such as Liz Degnen have highlighted their worries about Tameside, and the recent departure of its chief executive was called for and welcomed by several hon. Members. Does my right hon. Friend agree that the Keogh report is a vindication of many of my constituents’ long-held beliefs?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Yes it is, but I hope that we can give them confidence today that the problems will finally be addressed.

Photo of Jonathan Reynolds Jonathan Reynolds Labour, Stalybridge and Hyde

I have welcomed the Keogh process from the beginning. Although the report on Tameside is hard hitting, I entirely welcome it—it is consistent with what has been in the public domain for two weeks—and the evidence that all Tameside MPs gave to Keogh to demand a change in leadership has been justified. Although I speak as a MP who has campaigned critically against his hospital, may I say that the tone and comments of the Secretary of State were neither helpful nor accurate with regard to Tameside? We need him to focus on implementing the reforms that are needed, one of which is clearly to deal with the inadequacy of the previous inspection regime. The extent of the scrutiny of these 14 trusts was great, but that is needed for all hospitals, so can he tell us what he will do to put that into effect?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I absolutely can. The new chief inspector of hospitals starts work today. We would like him to start the new inspection regime, adopting the same methodology as the Keogh review, as soon as possible, but it takes time to assemble a team of expert inspectors. He plans to start a pilot round of inspections this autumn before getting into full swing next year, and all the hospitals on today’s list will be inspected again within the next 12 months.

Photo of Heather Wheeler Heather Wheeler Conservative, South Derbyshire

My constituents use Burton trust, so it is a sad day when it is on the list. Will the Secretary of State help to ensure that no barrier is placed between MPs and hospital boards so that there is total transparency and local MPs can help the boards in the future?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That open relationship between hon. Members and their local NHS trusts is extremely important and useful. We all have to recognise that sometimes we have to speak up publicly when there are problems at our local NHS trust, because we have to represent our constituents, and that is part of the change due to this process. In the end, the most important thing is to give people confidence that, when there are problems, we are a Government who are committed to sorting them out.

Photo of Tom Blenkinsop Tom Blenkinsop Opposition Whip (Commons)

Page 22 of the Keogh report clearly states:

“Contrary to the pre-visit data, when the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas. The reported data did not provide a true picture of the numbers of staff actually working on the wards.”

It goes on to say that that

“was compounded by an over-reliance on unregistered staff and temporary staff”.

Given that the Government have sacked more than 1,000 people in front-line nursing roles in seven of the trusts involved, what conclusion does the Secretary of State draw from that paragraph?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

It is funny how Labour Members like to accuse Government Members of making party political points, but then misrepresent the reality that there are 8,000 more clinical staff throughout the NHS than when their Government were in power.

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford

As my right hon. Friend says, transparency is vital. Stafford hospital has improved substantially since the spotlight was shone on it, although we are not complacent at all. One of the real problems we face is that good clinicians avoid management positions. What plans does he have to encourage young clinicians to undertake professional management training so that they can move into senior management positions in the course of their careers?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

As ever, my hon. Friend speaks wisely, because we know a key point is that we need more good clinicians to go into management positions throughout the NHS. I am in close discussions with the NHS leadership academy, which this Government set up, to determine what more can be done to guarantee that able clinicians who pass muster and go into management can get a job at the end of that process. In addition, we have to encourage people to go into challenging trusts, rather than always being attracted to the best trusts. Such a change has been managed in the schools system, so we need to achieve that in health as well.

Photo of Ian Austin Ian Austin Shadow Minister (Work and Pensions)

I supported the inquiry and worked hard to provide details from Russells Hall patients and relatives, and to arrange for them to meet Sir Bruce’s team. Although the hospital has not been put into special measures, there are clearly areas of concern because people are waiting longer for A and E than in 2010, infection rates have increased and staff morale has gone down. The report cites

“Inadequate qualified nurse staffing levels on some wards”.

The Secretary of State said that if staffing levels were the problem, he would sort that out, so what assurances can he give people in Dudley and the staff at Russells Hall that he is going to address those inadequate nurse staffing levels?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The same assurances I have given everyone else representing a hospital with troubles: we are totally committed to sorting out those problems—[Interruption.] Labour Front Benchers ask when, but we have said that these hospitals will be re-inspected in the next year. The structures that we are putting in place to sort them out are a million times tougher than anything that happened when they were in office.

Photo of Andrew Percy Andrew Percy Conservative, Brigg and Goole

I am proud of our local NHS, especially the examples of good practice highlighted at Goole hospital. However, as someone who works as a volunteer in the NHS every weekend, I meet patients who are frightened of going into local hospitals precisely because of the failings highlighted in the report on North Lincolnshire and Goole Hospitals Foundation NHS Trust. Will the Secretary of State visit Goole and north Lincolnshire to meet my constituents and discuss such individuals as an 88-year-old whose nails were not cut for seven months, whose toilet calls went unanswered and who ultimately died after contracting E.coli in our local hospital?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Of course I would be delighted to visit my hon. Friend’s local hospital. I am sure there will be a great deal that I can learn, and I hope I will be able to give encouragement to the staff there, who are working very hard in a very difficult situation. I hope today will give them encouragement that this is a Government who are determined to turn around their hospital.

Photo of Huw Irranca-Davies Huw Irranca-Davies Shadow Minister (Environment, Food and Rural Affairs)

On the basis of the very good and welcome Keogh report and also the Francis recommendations on safe staffing levels, does the Secretary of State feel that the reduction of 4,000 nurses over the past two or three years is in any way contributing to the very issues that he has described today?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We welcome and accept the Francis report’s recommendations on safe staffing and we recognise that that involves having doctors. We recognise and are pleased that our protection of the NHS budget means that there are 6,000 more doctors than when the hon. Gentleman’s Government were in power. If he looks at what is happening in his own Wales, he might find that there are a few lessons that the NHS in Wales could learn.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

Sadly, the problems at George Eliot hospital go back well over a decade, so these special measures will be very welcome, but is not one of my right hon. Friend’s fundamental problems dealing with a culture of secrecy, where in the past a board with a problem would talk to a strategic health authority board and nobody would know what was going on? Is not sunlight the best disinfectant?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

It is, absolutely. That is the big change. My hon. Friend speaks wisely. That is the big change that we have to make in our NHS. When there is failure, we must be open about it. It has to be public—we have to keep the public in the picture, because that is the best way of putting pressure on the system and on the politicians to make sure that they sort it out. That is not what happened before; it is going to happen now.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

Does the Secretary of State share my dismay that just as Julie Bailey was hounded out of Mid Staffs by the local Labour party for revealing the truth, some of the tone of this debate—accusations, sanctimoniousness and false victimhood—is a very tangible illustration of what whistleblowers have had to face for the past decade when they have tried to get the truth out? What a tangible demonstration, sadly, this has been.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is right. If some of those on the Opposition Benches knew exactly what Julie Bailey had to go through to expose the truth of what happened at Mid Staffs, they might think again about some of their behaviour this afternoon.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

Although proud of our local hospital, residents in Kettering will be pleased that Sir Bruce has managed to expose some dangerously run parts of the NHS, but they will be concerned to know what can be done to make the future far better than what has happened in the past.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Absolutely, and the big point about the changes that we are bringing in—I congratulate my hon. Friend, who is a huge supporter of Kettering hospital, which he and I have visited together—is that the NHS in many ways is no different from other parts of our public services: there are excellent bits and there are bits where there is poor leadership. What we have to do if we are to sort out the poor leadership is to expose it and to make sure that the public know about it and the politicians cannot duck sorting it out. My hon. Friend’s constituents will be thinking, as a result of tomorrow’s headlines, “What about Kettering hospital?” That is why we will have an independent chief inspector who will go round and tell them how good Kettering hospital is. However much they love it, he may well find things that need to be improved, and my hon. Friend and his constituents will welcome that.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale

Last week it was the CQC. Now it turns out that between 2005 and 2010 there were 386 separate warnings that the last Labour Secretary of State claims never to have received, yet the trust in my area was given foundation status. Does my right hon. Friend agree that given the new revelation by Sir Brian Jarman on suppression of warnings, along with existing allegations of spin and cover-up levelled against a former Secretary of State for Health, it is now time for the right hon. Gentleman to resign?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is a matter for the leader of the Labour party. What concerns me most is that the Opposition do not understand the fundamental policy mistakes they made which led to the entrenched culture of failure in too much of our hospital sector.

Photo of Nigel Mills Nigel Mills Conservative, Amber Valley

Those of my constituents who use King’s Mill hospital will understandably be concerned about their future treatment. What reassurance can my right hon. Friend give me that this summer those patients will get the treatment that they rightly expect?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

It is important to recognise that even at the hospitals that we are talking about this afternoon, there is good care happening every single day. The way that we will reassure my hon. Friend’s constituents is by having an independent inspection system which has not existed before, where regulators are not leaned on by Ministers to say the right thing in the run-up to elections. It is only when his constituents have confidence in that regulatory system that they will know the truth about their own hospital, and we want them to get there as soon as possible.

Photo of Neil Carmichael Neil Carmichael Conservative, Stroud

I welcome Sir Bruce’s report and the Secretary of State’s robust approach to it. Does my right hon. Friend agree that if we take away the right lessons from the statement and the questions on it, that will be the catalyst for a change of culture, enhancing transparency and accountability and introducing a new pace of response for the changes necessary to bring about higher standards in our hospitals?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We do need to draw those lessons, and the sad lesson from this afternoon is that that change in culture with respect to transparency and accountability does not extend to the Labour party. Voters will notice how unwilling Labour Members are to accept that things went wrong on their patch.

Photo of Andrew Stephenson Andrew Stephenson Conservative, Pendle

Given what today’s report says about capacity issues at Blackburn hospital, and that the hospital is struggling to deal with the number of patients, serious questions again have to be asked about the decision to downgrade Burnley hospital’s accident and emergency department under the previous Government in 2007, which was consistently supported by the shadow Secretary of State when he was in office. Will my right hon. Friend visit Pendle to meet some of the affected families to reassure them that lessons have been learned from the mistakes of the past?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will be delighted to visit my hon. Friend’s hospital, as well as those of many colleagues. I am sure I will learn a great deal when I do so.

Photo of Stephen Metcalfe Stephen Metcalfe Conservative, South Basildon and East Thurrock

I congratulate my right hon. Friend on having put patients first in the whole process. As we move forward, we should approach the failures of the past more in sorrow than in anger, but we have to accept that that is a hard ask for my constituents who potentially have lost loved ones because of the catastrophic failures of the past inspection regime. That is why my constituents are impatient for change. If hospitals do not make the changes necessary in the required time, what sanctions will be imposed?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The entire system will be accountable for making sure that change is delivered. That is part of the change that we are making through the statement this afternoon. My hon. Friend’s hospital will be inspected again within the next 12 months and we will be able to see what progress has been made. There will be further independent inspections after that, so his constituents will have confidence that an independent expert is casting an eye over the health care that they are receiving and telling them the unvarnished truth about whether they can trust it or not.