Managing Risk in the NHS

Opposition Day — [5th Allotted Day] — Paid Directorships and Consultancies (MPs) – in the House of Commons at 4:30 pm on 17th July 2013.

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Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health 4:48 pm, 17th July 2013

I beg to move,

That this House
is concerned about the Government’s approach to managing risk in the NHS;
notes that the Government is still to respond fully to the Francis Report, despite the Prime Minister promising on 6 February 2013, Hansard, column 281, a detailed response by the end of March 2013;
believes that the Government is in danger of ignoring the lessons of recent failures by cutting thousands of nursing staff;
is concerned at recent reports revealing pressure to roll out the NHS 111 telephone service despite serious concerns about it not being safe to do so;
is further concerned at recent reports that plans are not in place to avert an Accident and Emergency crisis next winter;
recognises that the 14 Trusts investigated by Sir Bruce Keogh have seen increasing problems since May 2010;
further believes that the Government’s failure to implement the key recommendations of the Francis Report, combined with the disruption of the recent NHS reorganisation, risks making it more likely that failures of care will happen in future;
further notes the Government’s recent commitment to openness and transparency in the NHS;
therefore calls on the Government to publish the NHS transition risk register as ordered by the Information Commissioner and Information Rights Tribunal;
and further calls on the Government to bring forward urgent implementation of key Francis recommendations to improve patient safety, including a duty of candour, benchmarks on safe staffing and the regulation of healthcare assistants.

I have called this debate today to try to map a way forward for an NHS which, right now, is feeling battered, bruised and under attack. It has just come through the worst crisis in accident and emergency for more than a decade and it is only months away from another winter which, if nothing changes, will most likely be just as bad or possibly worse for patients. I spend considerable time on the NHS front line shadowing staff, so I pick up what they say. They feel exhausted, unsupported and have a profound sense of uncertainty about where the NHS is heading. Today it is in a fragile condition. The way the Government conduct themselves in the coming months and the decisions they make will have a major bearing on their ability to manage the risks that the NHS is facing. For the sake of patients everywhere, they must urgently raise the morale of NHS staff and restore some trust. Later I will make some suggestions on how that can be done.

The Keogh report was a verdict not on the past, but on what is happening now. Standards have fallen, not only in the 14 trusts considered in the Keogh review, but across the NHS. Throughout the first six months of this year, hospitals were sailing dangerously close to the wind, operating way beyond safe bed occupancy levels, with general chaos in accident and emergency. How did we get here? To hear Ministers now, it is as though the last three years have not happened—it is all about the last Government. However, one of the main reasons why the NHS is struggling is the destabilising effect of a reorganisation that nobody wanted and nobody voted for. It is exactly three years since the bombshell of the “Liberating the NHS” White Paper landed on an unsuspecting NHS.

This Government falsely accuse the last Government of ignoring warnings, but warnings do not come much bigger than this: the story of the Health and Social

Care Act 2012, in a study that is aptly titled “Never Again?”—I think we can all say amen to that. It quotes senior civil servants who tried to encourage the former Secretary of State out of his grand plans to reorganise the NHS. One senior civil servant in the Department said:

“The biggest challenge was trying to get the secretary of state to focus on the money—the £20 billion and the sheer scale of the financial challenge”.

The Secretary of State’s attitude, however, was:

“I am going to do these reforms anyway, irrespective of whether there are any financial issues. I am not going to let the mere matter of the financial context stop me getting on with this”.

Another civil servant said:

“We did point out to him that his plans were written before the big financial challenge, and didn’t that change things? He completely did not see that at all. He completely ignored it”.

Photo of Andrew Percy Andrew Percy Conservative, Brigg and Goole

Will the right hon. Gentleman way?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I will give way to the hon. Gentleman, but I hope he will respond to what he has just heard.

Photo of Andrew Percy Andrew Percy Conservative, Brigg and Goole

If a few more of the shadow Secretary of State’s colleagues had turned up to this debate, they would be able to respond to those points for him.

If I may take him back to his comments about the challenges in A and E, which have been severe this Christmas and winter, does he accept that one of the things that he and his party got wrong in government was to cut beds and close wards before putting in place proper intermediate care services? People in my constituency could not get into their local hospitals this year because of the beds that were cut when his party was in government.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

The hon. Gentleman is doing what the Conservatives have been doing for quite a few weeks now, which is rewriting history. Does he recall the general chaos in A and E before 1997? Does he remember people waiting for hours on trolleys before they were seen or people spending a day in A and E departments? When we left government, 98% of trusts across the country were meeting the four-hour target. Sadly, we cannot say the same about the NHS on his Government’s watch.

What I have just given to the House was a warning of all warnings not to proceed with a reckless reorganisation at a time when the NHS was facing the biggest financial challenge in its history. Senior civil servants gave those warnings; the Government ploughed on regardless. That was a monumental mistake, combining the biggest ever financial challenge with the biggest ever reorganisation. Eyes were taken off the ball at the worst possible moment.

Photo of Dave Watts Dave Watts Labour, St Helens North

Does my right hon. Friend know when the Secretary of State last visited an accident and emergency unit? May I suggest, through my right hon. Friend, that he comes with me to my accident and emergency unit and sees the chaos he has created?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

Promises were made before the reorganisation to my hon. Friend and his colleagues in St Helens, Knowsley and Halton about the future of the hospital, because there was concern that certain commitments would not be honoured by the new organisations. And it came to pass: they were not honoured. My hon. Friend asked whether the Secretary of State had been to an A and E. We know that he did not turn up at one until April, yet he had already stood up and criticised hospitals for “coasting”. How on earth could he make such comments when he had not bothered to get his feet on the ground to see what was happening in the NHS? Unbelievable.

The Government took a huge gamble when they proceeded with the reorganisation at a time of financial stress and in the teeth of opposition from the public and the professions. If the Secretary of State truly believes, as he said yesterday, that transparency is a disinfectant—he is nodding—and if he wants to show leadership from the front from today onwards, should he not now commit to publishing the risk register that accompanied the Government’s reorganisation of the NHS? [Interruption.] He claims again that this was all about the last Government, but let me explain the difference to him. This Government withheld the risk register in defiance of the Information Rights Tribunal and the Appeal Court. Is he proud of that? What message does he think that that sends to the boards of those NHS organisations that he is now asking to act with maximum transparency? I am afraid that it sends absolutely the wrong message. He will not foster the right culture in risk management in the NHS if there is one rule for the Department and another for everybody else.

Photo of Andrew Selous Andrew Selous Conservative, South West Bedfordshire

What is the right hon. Gentleman’s view of the previous culture of secret board-to-board meetings, at which the boards of a local trust and a strategic health authority met in private to try to deal with issues? In retrospect, does he agree that that was probably not the best way to deal with serious issues, because the very people who were responsible would perhaps not get the blame?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

Let me give the hon. Gentleman a direct answer. One of the things that shocked me most when I received the Francis report, which I commissioned under the previous Government, was the revelation that on receiving foundation trust status, the board of Mid Staffordshire NHS Foundation Trust had begun to hold its meetings in private, rather than in public. It had taken the freedoms, yet decided to become more secretive. That was fundamentally unacceptable, and I made that point loud and clear to the NHS when I received that report. I do not think that there is any difference between us on this. I believe in openness and transparency too. Ours was the Government who brought in the Freedom of Information Act and independent regulation for the NHS. On that matter, we can make common cause.

Several hon. Members:

rose—

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I want to make some progress, but I will give way again later.

People have a right to know whether any of the recent pressure that we have seen in the NHS was predicted and made known to Ministers before they proceeded with their reorganisation, which has led to thousands of good, experienced, committed people leaving the NHS.

It left in charge less experienced people, who had never seen an A and E winter crisis and who did not know what to do. It led to millions in large redundancy payments being handed to people who were then re-employed by a new NHS organisation. Overall, £3 billion was siphoned out of the NHS front line to pay for this upheaval. Managers got six-figure pay-offs, and 4,000 nurses got P45s. It is no wonder that morale among staff is at rock bottom.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I will give way to the hon. Gentleman, but I hope that his intervention will not be about Wales. [Interruption.]

Photo of Alun Cairns Alun Cairns Conservative, Vale of Glamorgan

Mr Deputy Speaker, I can assure you that my intervention will be about Wales, because it is about my constituents who are suffering. Will the right hon. Gentleman pay tribute to the transparency that Ann Clwyd is seeking to enforce by exposing the different data that apply to Wales and England? Does he share my dismay that only 83% of patients who are admitted to A and E are admitted, treated and discharged in hospitals in Wales, compared with the 91% who are admitted, treated and discharged in hospitals in England? Why do my constituents have to wait 89 days, compared with the 51-day waiting time in England—

Photo of Lindsay Hoyle Lindsay Hoyle Chair, Panel of Chairs, Chairman of Ways and Means

Order. Mr Cairns, do not take advantage of the situation; it is not fair to other Members who also want to intervene. We want this debate to be heard in the best possible way.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

This is debate is about the NHS in England, and if the hon. Gentleman has concerns about the NHS in Wales, why does he not have a word with his right hon. Friend the Chancellor of the Exchequer and get a better deal for the Welsh Assembly so that a bit more money could be put back into the Welsh national health service?

As I was saying, the Government have put staff morale at rock bottom, and where are the promised benefits of this reorganisation? Clinical commissioning groups are not, as we were promised, the powerhouse of the new NHS; they are embryonic at best and anonymous at worst. Members of all parties, I am sure, write letters to CCGs that get passed to NHS England, which then either does not provide a proper answer or passes them on again. [Interruption.] I hear the public health Minister saying it is dreadful that Members do not get proper answers. When my hon. Friend Grahame M. Morris wrote to her about cancer services in his constituency, she also brushed it off to NHS England. Is this proper accountability? No.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I hope the Minister is going to deliver some accountability now.

Photo of Anna Soubry Anna Soubry The Parliamentary Under-Secretary of State for Health

Will the right hon. Gentleman please agree and accept that I have not only answered his letters, but met him on at least one occasion? It is right under the new system for such letters to go to NHS England, but that does not stop me making representations. We have introduced a much better system than we used to have under his Administration.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

We have just heard it; this is what the NHS has been reduced to. The Minister has to make representations to NHS England about cancer services of all things. My goodness, if Ministers are not responsible for cancer services, what are they responsible for? Who is making the decisions and who is responsible for what? Even now, confusion reigns.

What precisely is the role of the Secretary of State in this new world? He has cast himself in a new role as a detached commentator on the sidelines, magnifying all of the NHS’s failings and accepting none of the responsibility to fix them. I assume that that is all for NHS England, too. With the NHS already laid low by cuts and reorganisation, the Secretary of State has opened up a new front on staff: nurses repeatedly blamed for not caring enough; hospitals blamed for coasting, as I have said; GPs blamed for causing the A and E crisis. Everything is someone else’s fault.

Then we get to this weekend. The Keogh report rightly exposed poor care standards, which should never be tolerated; we support action to tackle to them. The report, however, exposed something else, too—a Government who are now actively spinning against the NHS for which they are responsible, generating misleading or, in Sir Bruce’s words, “reckless” headlines about 14 already troubled hospitals. What chance do they have of improving when the man supposedly in charge is actively doing them down?

Photo of Derek Twigg Derek Twigg Labour, Halton

My right hon. Friend mentions the Keogh report and we are talking about the present day. Keogh says in the report that he 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.”

There we have it: it is this Government who are not making sure that our hospitals are properly staffed.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I am grateful to my hon. Friend and I will come to that precise point, as one would think that that was a responsibility of a Secretary of State. Who knows, though, what their responsibilities are now. Presumably that is a matter for NHS England as well. We shall return to the point in a few moments.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

No, I want to make some more progress.

As I said a moment ago, what chance do these hospitals have when they get these misleading headlines running them down when they are trying and struggling to make progress, alarming staff, alarming patients, demoralising staff and casually trading figures—[Interruption.] No. I will not give way. [Interruption.]

Photo of Lindsay Hoyle Lindsay Hoyle Chair, Panel of Chairs, Chairman of Ways and Means

Order. If the right hon. Member wants to give way, he will give way. We do not need people standing up, shouting and bawling. I want to hear what the shadow Secretary of State has to say, just as I want to hear what the Secretary of State has to say. Let us have a little more courtesy from everyone.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

Thank you, Mr Deputy Speaker.

Alarming patients, demoralising staff and casually trading figures about deaths in the pursuit of political advantage is no way to run the NHS, and those are not the actions of a responsible Government. Today people are asking what kind of Government this is, if they are willing to cause further damage to fragile hospitals for their own self-serving political ends. Yesterday the Secretary of State told the BBC that he had no idea who had put the 13,000 figure in the public domain. Does he seriously expect us to believe that?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

He seriously expects us to believe it? Why are we being told that those responsible were representatives of Conservative Central Office? [Interruption.] Yes, that is what is being said. The Secretary of State should go back and check his facts. If he does not have control of his advisers, it will not be the first time, will it? We have heard this before, have we not? “I do not know what the advisers are doing.”

The “my adviser is out of control” defence may have worked for the Secretary of State once, but it will not work for him twice. He must take responsibility for his own advisers, and for the advisers at Conservative headquarters. We were told explicitly that that is where the briefings came from, and the Secretary of State owes the House a full answer. He owes it to the House to put that on the record. [Interruption.] I will not put the name in the public domain, but I have a name. I will send it to the Secretary of State immediately after the debate, and he must come straight back to me, having asked that person whether or not he briefed the press. If the Secretary of State agrees to that, let us leave it there. I have a name, and I will put it to him straight after the debate. He must take responsibility.

Photo of Kevan Jones Kevan Jones Shadow Minister (Defence)

If there was no organised briefing over the weekend, there must have been a coming together of some extraordinary fiction. The Keogh report itself states:

“It is important to understand that mortality in… NHS hospitals has been falling over the last decade: overall mortality has fallen by…30%”.

Keogh says that that is an improvement, even given

“the increasing complexity of patients being treated”.

Those who read the headlines, and the spin from the Conservative party, would not think that our investment over 13 years had made any difference to mortality rates.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

My hon. Friend has made an extremely important point. The conclusion to which he has referred may well have been missed by many people up and down the country yesterday, but it is worth repeating and putting centre stage in today’s debate, because the Government certainly will not make any reference to it.

NHS hospitals in England, including the 14 covered by the review, have reduced mortality by 30% in recent years. That is an incredible achievement, which we should surely be celebrating. Of course the NHS is not perfect. It does fail people, and when it does, we are truly sorry for the effect on their families. The fact is, however, that the NHS and its hospitals have improved over the past decade, and that needs to be repeated and repeated to counter the scare stories that are emanating from the Conservatives and the fears that they are stoking among people about going into hospital.

Photo of Graham Stuart Graham Stuart Chair, Education Committee

I wonder whether the right hon. Gentleman is aware of the work of Professor Sheena Asthana, who has studied hospitals with higher mortality rates and found a correspondence between hospitals serving clinical commissioning groups—formerly primary care trusts—in areas with older populations which are receiving lower funding allocations than those with younger populations. She believes that funding allocations could be one of the causes of higher mortality across the system.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I would not close my mind to that suggestion, but I think it important also to take account of what Keogh said about other similarities between those hospitals—and, probably, between them and Mid Staffordshire. What they have in common is geographic isolation. Hospitals serving smaller market towns are not supported by the same clinical networks as others, and may find it more difficult to attract qualified staff. I agree with the hon. Gentleman that there are a number of important issues that need to be considered.

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

My right hon. Friend knows well, and knows personally, that in the past two months there has been a marked change in the coalition Government’s approach on the national health service. It started with the absurd argument that the problems in accident and emergency departments were the result of the 2004 GP contract. Is it not more likely that what is happening is that Mr Lynton Crosby is telling Government Members to squeeze the lead that Labour has had over the Conservative party for many decades on the NHS, and attacking NHS workers, scaring patients and attacking the Opposition is what they are trying to do? They ought to be ashamed of themselves for being involved in it.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

It used to be, “We love the NHS”—the Prime Minister said, “I love the NHS”—but now it is about running down the NHS. I say to the Secretary of State, in all sincerity, that he will not improve patient care by continually blaming doctors and nurses. As I have said before, the NHS is fragile right now because of his reorganisation, and it cannot keep taking these knocks on a daily basis. The blame game is destructive and polarising, and it has to end. He is in real danger of losing any remaining good will in the NHS work force, and none of us and, more importantly, none of our constituents can afford to see those crucial staff become fed up, lose heart and walk away. Government Members can throw whatever they like at me, because that is politics, but I will not allow the NHS and its staff to become collateral damage in this orchestrated political campaign.

Photo of Penny Mordaunt Penny Mordaunt Conservative, Portsmouth North

The right hon. Gentleman is making some important points about accountability, responsibility and the grip the Secretary of State should have on his Department. In that vein, can the right hon. Gentleman please tell the House how many of the 400 warnings about United Lincolnshire, 300 warnings about Blackpool and more than 200 warnings about Basildon went across his desk?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

This is all part of the spin in which Government Members have been engaging in recent days. [Interruption.] Okay, so let me answer and then the same test will apply to the Secretary of State as the hon. Lady is applying to me. She is referring to letters sent by members of the public to the Department of Health. I am sure that this has not changed with the change of Government; contrary to what she has just said, those letters do not come across Ministers’ desks. They are not formal warnings to Ministers, and it is very important to be precise with language here. This Secretary of State will have received many, many hundreds of letters about hospitals up and down the country that he will not have seen, and it is not right for the hon. Lady to come along, again, with slurs and half truths to try to muddy the waters.

Photo of Charlie Elphicke Charlie Elphicke Conservative, Dover

With respect, I do not think the right hon. Gentleman’s answer to my hon. Friend Penny Mordaunt is good enough and convincing enough. We have heard too much about concern for hospitals and for hospital staff from the right hon. Gentleman, but not enough about concern for patients and for patient care.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

If the hon. Gentleman was listening, I said just a few seconds ago that the Secretary of State will not improve care for patients if he continually blames nurses and doctors. It is not one or the other, although Government Members seem to think they can attack the health unions for somehow being the enemy of patients. Ordinary people do not see it that way. They know that the staff are there for them day in, day out. We support the staff to help the patients. If staff are rewarded properly and have good working conditions, they will provide better care to patients. These are not opposites; the two go together, and the Conservative party would do well to remember that.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

Some of us were here during the time of the previous Conservative Government, and I can remember that one of the hospitals in Coventry badly needed repair. After 1997, we got a new hospital. More importantly, one thing that Government Members always boast about is that they have increased the number of trainee doctors. It takes seven years to train a doctor. This Government are in their third year, so the credit goes to us.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

As so often with the spin that we hear from Government Members, it is our achievements they are trying to claim credit for. I left behind the plans for the training of those doctors, but we do not hear much credit coming in this direction, do we? Government Members are happy to take the credit and then they try to cast off all the blame for everything else. My point is that criticism must be fair and made with care. We all have a duty to point out the failings of the NHS, in our own constituencies and nationally, and that is what I did when I did the Secretary of State’s job. However, we have to do that responsibly and fairly, especially for hospitals and those who manage them.

Hospitals are not the architects of all the problems we read about. For example, they are all struggling with the fallout of severe cuts to social care budgets, the appalling cost of which I recently revealed: a 66% increase over two years in the number of over-90s coming into A and E via blue-light ambulance. In human terms, more than 100,000 very frail and frightened people have been speeding through the streets of our communities in the back of ambulances. Hospitals have to absorb that extra pressure and also struggle with longer delays in getting people back home. We are in real danger of asking too much of our hospitals by allowing them to be the last resort for people who would be better supported elsewhere. Without a greater understanding of that situation in the current debate, and if the trend towards the vilification of NHS managers continues, who will take on the job of running our acute trusts? Good people will walk away and no one will want to do the job. Again, the NHS simply cannot afford that.

This crude blame game is an election strategy with two components: run down the NHS; and pin all the failings on the previous Government. The NHS cannot take 20 months of that until May 2015. It has been destabilised and demoralised already; if the Government are not careful, they will push it over the edge.

The Secretary of State needs to change course and find a way of bringing people back together, so the purpose of the debate is to put forward two constructive proposals to manage risk in the NHS—one for now, the other for the long term. First, I turn to the immediate proposal. It is clear that the best way to draw a line under recent events and unify people would be for the House to embrace today the analysis and main recommendations of the Francis report. The motion highlights the three most significant recommendations: benchmarks on safe staffing; a duty of candour on individual NHS staff; and the regulation of health care assistants. If all parties endorsed those proposals, it would send staff a message of support and recognition of the pressure that they are under, while the patients who have suffered poor care would receive the positive message that the parties are working together to prevent that from happening to others.

Given the tragic events that lie behind them, public inquiries should, when possible, produce consensus. It is extraordinary that, having commissioned a three-year public inquiry, the Government have slowly been distancing themselves from the Francis report’s analysis and conclusions ever since its publication. It is hard not to conclude that the report did not deliver what the Government wanted and that they have spent the past five months rewriting it. They have come up with their own recommendations on chief inspectors for hospitals, general practice and social care, yet dragged their feet on the actual recommendations. They have substituted the verdict of Francis on Ministers in the previous Government with that of the kangaroo court of Lynton Crosby. We do not oppose chief inspectors, but if the Government believe that ever-tougher central regulation will bring about the culture change locally that everyone agrees is necessary, they are mistaken. We need change that will have an immediate effect on the ground, and that will support staff and improve care for patients.

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

My right hon. Friend has probably been in the Chamber on most of the occasions when I have raised the question of safe staffing with the Secretary of State. It was cited in the Francis and Keogh reviews, and the Care Quality Commission tells us that one in 10 hospitals has unsafe staffing levels. The Secretary of State dances around the issue again and again, but he will not take action. Yesterday, I asked him to introduce transparency to the process so that hospitals do not have wards with ratios of two staff to 29 patients, but he refused to answer my question. Does my right hon. Friend agree that if hospitals were transparent about their ratios, that would be the way forward, because we would know where we were?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

The Keogh report exposes alarming ratios at my hon. Friend’s hospital and others. We have been warning the Government for months—years, in fact—about cuts to nursing numbers. It is neither right nor fair to criticise nurses for being uncaring when too many of them are unsupported and working in conditions in which they have to make compromises that they would rather avoid.

Staffing emerged as the main concern arising from the Keogh report, but the problems go way beyond 14 trusts. The CQC says that one in 10 trusts in England does not have adequate staffing levels. Can we agree today that the staffing in all hospitals must urgently be brought back up to adequate levels, as defined by the commission, with clear benchmarks set for the future? [Interruption.] I am pleased if the Secretary of State is agreeing, because that represents progress, so I look forward to finding out how his plan will be delivered.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

The right hon. Gentleman will remember that yesterday I drew attention to the fact that all but one of the 14 hospitals Keogh reviewed had staffing and skill mix issues that needed to be dealt with, but it would be quite wrong to suggest that that has happened only in recent years. Graham Pink drew attention to the problem in the early ’90s, and it also happened during Labour’s years in government. I think that it would be good for this debate if the right hon. Gentleman at least acknowledged that it has been going on for more than three years.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I will acknowledge that. A moment ago, I mentioned the Francis report, which I commissioned, which revealed the dangerous cuts to front-line staffing that the hospital pursued as the primary cause. I accept what the hon. Gentleman has just said. Rather than always pursuing central regulation as the solution, if local communities had identifiable benchmarks that they could use to check up on their local hospitals, surely that would be progress we could all get behind.

On the duty of candour, the Government are legislating for a duty on organisations, but not on individuals. I think that we all agree that changing the culture of NHS organisations is essential if we are to move forward. The Francis recommendation is a necessary part of bringing about that culture change. Rather than being a threat to staff, as some have argued, it would protect them when they make known any concerns. Will the Government look at that again and legislate for the full Francis recommendation in the Care Bill? That is incredibly important in the light of yesterday’s report by Sir Bruce Keogh. He revealed—this will shock anyone who has not spotted it yet—that some trusts were telling members of staff what they could and could not say to his review. Surely we can all agree that is fundamentally unacceptable.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I am glad that the Secretary of State nods. Does that not make the case, however, for a duty of candour on individuals, which would have allowed staff to say to management, “No, I’m going to speak to the Keogh review and I won’t face action afterwards because it is my duty to do so”?

Photo of Brian Binley Brian Binley Conservative, Northampton South

It is generally accepted that there were some serious management breakdowns. The Secretary of State at the time was the chief executive of the organisation. In my business, I would want to know what was happening. Does the right hon. Gentleman accept that he should have known what was happening?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I always took action when anything was brought to me. When mortality data on Basildon hospital were published, I immediately ordered an in-depth review of all hospitals in England, which led to warnings on five of the trusts on the Keogh list. Those warnings were inherited by the hon. Gentleman’s Government, but Ministers allowed those trusts to carry on cutting staff, and the same was true for the hospital in the constituency of my hon. Friend Andrew Gwynne, even though it was subject to a warning about patient care. I think that Government Members have to look at themselves before making claims.

On the duty of candour, the final recommendation that we need to see progress on relates to the regulation of health care assistants, which is long overdue. If the Secretary of State took these three sensible measures, he would provide support to staff and reassurance to the public, but they are not in themselves the answer to the structural challenge the NHS faces. That brings me to my final point on the longer-term solution. I have thought long and hard about what happened at Stafford hospital and why we hear recurrent echoes of the same elsewhere in the NHS, with older people lost on acute hospital wards, disorientated and dehydrated. I believe that the problem goes far deeper than any regulatory solution. Governments of all colours have underinvested in social care over many years, and in the end we get what we pay for: a malnourished, minimum wage system that dishes out care in 15-minute slots, which is barely time to make a cup of tea, let alone exchange a meaningful word.

Looking after someone else’s parents should be the highest calling that any young person can answer. However, if we are honest with ourselves, the effect of decisions taken here in this House over many years means that the signal we are currently sending is that it is the lowest calling that a young person can answer. Some 307,000 care staff in England—20% of the work force—are on zero-hours contracts. That is an appalling figure. This situation cannot carry on. Good care cannot be provided on a zero-hours, here-today-gone-tomorrow basis.

The collapse of decent social care in England means that too many elderly people are drifting unnecessarily towards hospital. Our hospitals are becoming increasingly full of very frail, very elderly people, and that is not sustainable in either human or financial terms. That is why I have proposed—

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford

I understand what the right hon. Gentleman is saying about the situation of care assistants—their low pay and so on—but in Stafford some of the highest-paid people in the organisation showed the least compassion. It is not all about money, although money may come into it. Compassion does not have any regard to income.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I agree with the hon. Gentleman, and I respect the way in which he continues to pursue the issues arising from what happened in his constituency. Yes, it is not all about money, but it is about the message we send to the people working in our care system. If somebody does not have certainty about the money that they will bring into the family home from one week to the next because they do not know how many hours they will be working, how can we expect them to pass on a sense of security to those they care for? We will not get the care that we all want for everybody’s parents if we carry on with a system that is working as it is. I lay the blame with no one Government; as I said, all Governments have brought this situation about.

That is why I have proposed the full integration of health and social care with one service looking after the whole person and all their needs, physical, mental and social. I hear the Government increasingly borrowing our ideas and our language, and I have no objection to that. However, here is my challenge to the Minister of State, who has been roused by that statement: he cannot speak the language of integration while legislating for fragmentation and competition. We are hearing reports from across the country of sensible collaboration between secondary, primary and social care being blocked by the competition provisions of the Health and Social Care Act 2012. Torbay, the beacon of integrated care, fears that any qualified provider may break up its celebrated model. That has led the Minister to suggest in the Health Service Journal that his integrated care pilot area might be offered exemptions from the Act’s competition provisions. Surely that is the clearest admission from the Government that the Act they passed is a barrier to the change that the NHS needs. Collaboration or competition? Integration or fragmentation? In the end, they have to make a choice; they cannot have it both ways. If the Minister is serious about this, the last offer I make is that we will work with him to fast-track repeal of the competition provisions of the Health and Social Care Act.

Today I have made some positive suggestions about a way forward for the NHS. It is now up to the Government to decide what they want to do. In the past few days, we have seen a glimpse of a Government prepared to run down the NHS, still the country’s best-loved institution, for their own political ends. If, from here on in, they intend to continue with that approach, they will be pursuing a very dangerous path. It will cement an impression in the country that some people have already formed—that the Secretary of State is running down the NHS to erode public confidence in it and to soften it up for privatisation. People suspect that that is the real agenda. Only today, we learned of six NHS trusts preparing for a major expansion in private work under privatisation freedoms given to them by this Government.

Nye Bevan said that there will be an NHS for

“as long as there are folk left with the faith to fight for it.”

I can tell all Government Members that they have not knocked the fight out of me, and I suspect there are millions out there ready to rally to the same cause. People rely on an NHS that puts patients before profit, and Labour will always defend that. This week the Government have revealed their hand and it is nasty. They should pull back or get ready for the fight of their lives.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health 5:30 pm, 17th July 2013

I beg to move an amendment, to leave out from “House”
to the end of the Question and add:

“welcomes the Government’s swift action in response to the Francis Report;
notes the rapid establishment of reviews on key components of the Report’s findings, including the Cavendish review on healthcare assistants, the Clwyd-Hart review on complaints and the Berwick review on patient safety;
further notes the drive to improve standards through the appointment of a Chief Inspector of Hospitals, the introduction of Ofsted-style ratings and the recruitment of specialist hospital inspectors;
regrets the Opposition’s continued refusal to support these practical measures to expose and improve poor care;
welcomes the watershed decision to expose and investigate 14 hospitals with high death rates through the recent Keogh review;
further notes the Government’s decisive action to drive improvements in these hospitals by placing 11 hospitals in special measures;
and applauds the Government’s wide-ranging efforts to introduce greater transparency and accountability in the NHS.”

I am honoured to see you, Mr Speaker, in your place for my speech. Andy Burnham talked about yesterday, and I for one hope that he has had a chance to reflect on Labour’s shockingly inappropriate behaviour. Let me give him one fact to think about: on a day when a review described appalling failings at 14 hospitals, my speech mentioned patients 19 times—his mentioned them just twice. Does that not say it all about Labour’s attitude to the NHS?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I listened carefully to what the Health Secretary just said about our speeches. Does he think it appropriate for a Secretary of State introducing a report on mortality rates in the NHS to begin, within seconds of getting to his feet, by making political attacks on the previous Government? On reflection, was that the right thing to do?

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

It is funny how the Labour party decided to make the NHS its main campaigning issue for the past three years, yet the moment people start to scrutinise its own record on the NHS it says the NHS is being used as a political football. What does that say about Labour’s approach to the NHS?

I want to consider the specifics of the motion before looking at the wider issue of risk. The motion mentions the Francis inquiry. One of this Government’s first acts on coming to power was to set up the full public inquiry into Mid Staffs that families had been denied by the right hon. Gentleman’s Government for too long. We are implementing it, and fast. That is why a new chief inspector of hospitals started work yesterday, just five months after the report was published.

[

Interruption.

]

The right hon. Gentleman says that a chief inspector of hospitals is not in the report, but how are we going to make sure that the report’s recommendations are implemented throughout all 266 NHS trusts? That will be done because we will have independent inspection of hospitals, which has not been done before because the situation was so undermined by the previous Government. That is how we are going to make sure that Francis actually happens.

We intend to implement the spirit of everything that Robert Francis proposed, even if the details may vary in places from his 290 recommendations. Francis himself endorsed that approach when that he said that the Government have indicated their

“determination to make positive changes to the culture of the NHS, in part by adopting some of my recommendations and in part through other initiatives.”

Francis talked about five themes, so let us look at the progress being made on them. First, on information and transparency, yesterday showed that this Government are determined to root out, once and for all, an NHS culture of solving problems behind closed doors. This is about not just the decision to hold a public inquiry into Mid Staffs, which the right hon. Member for Leigh and his colleagues rejected doing 81 times, but the Keogh review, which reported yesterday that 14 hospital trusts have excess mortality rates. This is the first time the NHS has ever conducted such a review. We have also published individual surgeon outcomes—the first country in the world to do so across an entire health system. The independent rating of hospitals will start this autumn, so for the first time people will know how good their local hospital is, just as they do for their local school.

Francis also mentioned standards. The new chief inspector of hospitals—a position that Labour still refuses to support—began work yesterday. In Professor Sir Mike Richards, we have a new whistleblower-in-chief whose sole job is to drive up standards and root out poor care. He will be supported by a team of expert inspectors, in stark contrast to the generalist inspection model set out by the right hon. Gentleman’s Government in 2009. That is plain common sense. We have put it right. The work of the inspectors will be informed by the independent review of hospital safety that is being conducted by Professor Don Berwick, who will advise on how to embed a culture of patient safety throughout the NHS. He will report back later this summer.

Photo of Derek Twigg Derek Twigg Labour, Halton

Yesterday, when I asked the Secretary of State whether mortality had fallen before 2010, his answer was:

“According to Professor Jarman…it has been falling slightly.”—[Hansard, 16 July 2013; Vol. 566, c. 944.]

The Keogh report states that it had fallen by 30% over 10 years. Figures from the House of Commons Library, which were sourced from the NHS, show that there has been a significant fall in deaths within 30 days of non-elective hospital procedures. Will he correct the record?

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

I am afraid that that intervention sums up where the spin is happening. The 14 hospitals were investigated by Professor Keogh because they had excess mortality rates. The Labour party thinks that that started in 2010, but it goes right back to 2005 in those hospitals and earlier than that in many of them. That is the ugly truth that Labour refuses to confront: 14 hospitals had high mortality rates for years and years, and Labour did nothing to sort it out.

The Francis report—

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

I am going to make some progress. The Francis report also talked about leadership.

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

I will give way in a moment.

The right hon. Member for Leigh talked about leadership. I want our NHS to attract the brightest and best leaders that this country has to offer. I have asked the NHS leadership academy to develop a new leadership programme to support clinicians to become clinical chief executives and to fast-track professionals from outside the NHS into leadership roles. We urgently need more talented managers in our NHS, and that will make a big difference.

Photo of Andrew Percy Andrew Percy Conservative, Brigg and Goole

I want to take my right hon. Friend back to the comments of the right hon. Member for Leigh, which I found shockingly complacent. I will give the example of Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, which is one of those that is in special measures. Our mortality rates started to go up in 2007 and started to fall in 2011, but our nursing numbers have been increasing over that whole period. I find it shockingly complacent for somebody to suggest that there is not an issue or to downplay those figures. In my area, that has potentially cost hundreds of lives.

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

My hon. Friend makes an important point.

I say to the shadow Secretary of State that it is a question not just of whether he responded to the warnings that he received, but of whether he received the warnings that he should have received in the first place because the inspection system might not have been up to scratch.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I mentioned a moment ago that when I saw the mortality data in late 2009, action was taken at Basildon and a review was ordered of all hospitals in England, so I did respond.

The Secretary of State needs to correct for the record something that he said a moment ago. He implied that the mortality ratio had not come down at the 14 hospitals. If I have got him wrong, he needs to be clear about it. Yesterday, a group of Back-Bench MPs was informed by Sir Bruce that mortality ratios at the 14 hospitals had fallen since 2005 by between 30% and 50%, but that they were still above the average for England. Overall, the mortality rate is down at all hospitals, but the 14 hospitals have rates that are above the average. Will he correct that point because it is incredibly important?

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

Let me help the right hon. Gentleman out. Those 14 hospitals were investigated by Professor Keogh because they had excess mortality rates that go right the way back to 2005. Labour cannot be in denial. Professor Brian Jarman said that under Labour, there was “total denial” in the Department of Health over the issue of excess mortality—

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

Order. We must try to preserve some sense of order and decorum in this debate. The Secretary of State can be expected to answer only one intervention at once. It is unseemly and arguably discourteous of other Members to jump up and try to interrupt the Secretary of State when he is dealing with the previous intervention. Let us deal with that first. Members must show some sensitivity to that.

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

Thank you, Mr Speaker. Let me make some progress.

On leadership, there has to be accountability for failed leadership through the introduction of a national barring list for unfit managers, similar to the one that we have for teachers.

Photo of Chris Kelly Chris Kelly Conservative, Dudley South

The Dudley Group NHS Foundation Trust is one of the 14 trusts that were reviewed by Sir Bruce Keogh. Will my right hon. Friend confirm what changes this Government have made to provide central accounting in the NHS for compensation payments that were inherited from the Labour party, under which there were no financial consequences for unacceptably poor performance and weak leadership, such as that experienced in my constituency?

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

This is the appalling fact: we have inherited from the previous Government a system of compensation payments with no significant financial penalty on trusts that have to pay out litigation claims. The focus on patient safety, the biggest discipline of all that any trust should have to reduce patient safety incidents, should be the thought of having to pay compensation. That disincentive was removed. Absolutely, we will look at that.

Photo of Grahame Morris Grahame Morris Labour, Easington

Will the right hon. Gentleman give way?

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

I am going to make some progress and I will give way more later.

Francis also talked about compassionate care. We are going to follow the advice of Camilla Cavendish’s study on training for health care assistants, so we can be sure that no one is giving basic care to our NHS patients without proper training on how to treat people with dignity and respect. We have also proposed that, subject to pilots that are starting in September, every student who wants to receive NHS funding for their nursing degree will first work for up to a year as a health care assistant, so that before they open the textbooks they learn real care and compassion at the coal face.

Photo of Andrew Smith Andrew Smith Labour, Oxford East

Will the right hon. Gentleman give way?

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

I am going to make some progress and then I will give way.

In addition, in September Ann Clwyd and Professor Tricia Hart will present their recommendations on how we can turn NHS complaints handling into an engine for improving compassionate care.

The right hon. Member for Leigh mentioned nursing numbers. Getting the right number of staff on wards does matter, and where that is not happening for hospitals in special measures it will be sorted out. However, to suggest that that is the only issue, or indeed the main issue, is completely to misunderstand what has gone wrong. Eight of the 11 failing hospitals had increases in nurse numbers since 2010, but they still needed to go into special measures. Training, values, clinical safety and, above all, leadership are often as important.

Labour has been calling for mandatory minimum staffing numbers. Let us look at what the experts say about that idea. Robert Francis said:

“To lay down in a regulation, ‘Thou shalt have N number of nurses per patient’ is not the answer. The answer is, ‘How many patients do I need today in this ward to treat these patients?’”

He also said:

“The government was criticised for not implementing one, which it is said I recommended, which I didn’t.”

Photo of Cheryl Gillan Cheryl Gillan Conservative, Chesham and Amersham

I am grateful to my right hon. Friend for giving way, because he knows that Buckinghamshire Healthcare NHS Trust was included in the statement yesterday. The trust welcomes his leadership and the opportunity to improve its performance, so that it can give the best possible care to patients in Buckinghamshire. Does my right hon. Friend agree that training goes to the heart of quality, particularly of agency staff? Would he like to say something about the competence, quality and checks that are made on agency staff, which will help to improve the health service across the country?

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

My right hon. Friend makes an important point. There are many locums who work extremely hard and are very committed. However, it is true that one feature of a number of the failing hospitals in yesterday’s report was that they had a high proportion of locum staff. It is harder to build up a sense of teamwork if there is a huge turnover in the people working in NHS organisations, and I know that many will reflect on that.

Photo of John Pugh John Pugh Liberal Democrat, Southport

Will the right hon. Gentleman give way?

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

I will make some progress and then give way, because I want to come on to one of the main things that the right hon. Member for Leigh said, which was to criticise an NHS reorganisation that has put 8,000 more people on the frontline of the NHS.

The right hon. Gentleman said that that reorganisation cost £3 billion, when he knows full well that the National Audit Office shows that it will be half that amount. It will save £5.5 billion in this Parliament alone. For the avoidance doubt, it is that £5.5 billion saving that means we are now employing 1,000 more health visitors, 1,400 more midwives and 5,600 more doctors than at the previous election.

The right hon. Gentleman talked about the risk register. Let us look at what he said about publishing the risk register when he was Health Minister in 2007. These are his own words:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Hansard, 23 March 2007; Vol. 458, c. 1192W.]

I agree with him.

The right hon. Gentleman is right that pressures on A and E are building, so why does he oppose changing the GP contract to make primary care more accessible? Why does he criticise the extra £2 billion being put into joint commissioning by health and social care systems to reduce the number of delayed discharges? Why does he tell the NHS Confederation he supports the reconfiguration of services and then refuse to support every difficult reconfiguration, such as at Trafford or Lewisham?

Photo of Joan Ruddock Joan Ruddock Labour, Lewisham, Deptford

Is the Secretary of State aware that in the league table of the busiest A and Es in London, St Thomas’s, Queen Elizabeth and King’s occupy the second, fourth and sixth places? Does he really think there is no risk in moving tens of thousands of patients from Lewisham A and E to those three utterly overburdened and full-to-capacity hospitals?

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

I take the risks the right hon. Lady talks about very seriously, and we need to be very careful in managing any change, but there are also big risks in not making change. South London Health Care Trust is one of the worst-performing in the country, and it was used by her constituents. I have a duty to sort out these problems in the NHS, which have been left unsorted for many years.

The right hon. Member for Leigh said we should look at our record since 2010. Let us look at that record: the numbers of people waiting longer than 18 weeks, 26 weeks and 52 weeks to start treatment are lower than at any time under the last Government; as I said, we have 5,600 more doctors; and we have a £650 million cancer drugs fund, giving more than 30,000 people access to cancer drugs—his Government refused to set up such a fund; the number of mixed-sex wards is down by 98%; and hospital infection rates have halved. These are real achievements for a service under great pressure, and we should recognise the hard work and dedication of the NHS staff who have delivered them.

Photo of Graham Stuart Graham Stuart Chair, Education Committee

My right hon. Friend will have heard me earlier referring to the work of Professor Sheena Asthana and will know of my concerns about the allocations underpinning some of the risks in the NHS. Will he agree to meet Professor Sheena Asthana and me, perhaps over the summer recess, to discuss the matter further?

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

I would be delighted to do so. I have studied her work and am an admirer of it, so I would be more than happy to meet my hon. Friend to discuss further the issues he wants to raise.

I want to turn to the substance of the motion, which is about risk for the NHS. Two big risks face the NHS. They face not only the NHS, but all major health care systems. The first is financial sustainability and the second is an ageing population. The litmus test for the success of the NHS in the next 65 years will be whether it confronts those huge challenges while looking after people with dignity, compassion and respect. I believe that there are three pillars on which we must build to make that possible. The first is a radical transformation of out-of-hospital care. We know that a consultant is responsible for us when we are inside hospital, but who is responsible for a vulnerable older person when they leave hospital? Too often, their care falls between the cracks, with no one being accountable. The NHS could lead the world in this, but we have made it impossible for GPs to look after people proactively because of how the GP contract works. We need to change that, so that in an integrated, joined-up system of care, there is always an accountable clinician or named GP and the patient knows who it is. In the consultation on the changes to the NHS mandate for next year, therefore, I have asked NHS England to ensure a named clinician responsible for every vulnerable older person.

The second of the three pillars we need to reduce risk in the NHS is technology. The technology revolution has transformed many other sectors, but has barely touched the NHS. A and E departments cannot access GP notes and so give medicine without knowing people’s medication history. Ambulances pick up the frail elderly without knowing whether they are diabetic or have dementia. This has to change. Technology can also cut costs. Retail banks have reduced their costs by a third, and we need those precious savings for the NHS, which is why I have said I want the NHS to go paperless by 2018 at the latest, with online prescriptions and booking of GP appointments by 2015. Technology is also a vital key to delivering integrated care, which is why data sharing will be a key condition of accessing the £3.8 billion joint health and social care fund announced by the Chancellor in the spending review.

The final pillar to help the NHS cope with new risks is science. It might surprise hon. Members that I mention that today, but the UK has a long track record as a world leader in medical science. We were the first to unlock the secrets of DNA in 1953; we did the first combined heart, liver and lung transplant; we invented in vitro fertilisation, alongside many other advances, and we must play to those strengths. Science can transform our understanding of disease, and help us deliver truly personalised care. Our aim is by 2015 to put the UK at the forefront of the genome revolution worldwide, and I have set up Genomics England, led by Sir John Chisholm, to deliver that vision.

In conclusion, the NHS faces many risks, but it also delivers many successes day in, day out. No organisation anywhere in the world has more staff dedicated to the noblest ambition anyone can have—to be there for us and our loved ones at our most vulnerable.

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

I am concluding now. We owe it to those people to tackle head-on the risks the NHS faces alongside health care systems in every other country. We do so with confidence and optimism that by confronting failure, nurturing excellence, and supporting the brilliant work of people on the front line, we will be able to deliver an NHS that remains the envy of the world.

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

Order. In the light of the number of right hon. and hon. Members seeking to contribute to the debate, I am forced to impose a six-minute limit on Back-Bench speeches with immediate effect.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras 5:51 pm, 17th July 2013

I do not wish to get involved in great party turmoil on this matter, but it seems to me that a characteristic of any health care system is whether it is entirely devoted to managing risk. When people are ill or injured, their lives and health are at risk, and it is also possible that any treatment they may be offered will itself be risky.

The principal problem faced by doctors, nurses and midwives is that of uncertainty, and they want to give the right diagnosis. It is statistically true, for example, that the average GP will be confronted by 1.5 patients who are suffering from meningitis in a 35-year career, yet we expect them to make the right diagnosis. It is difficult. If the GP has made the right diagnosis—I am not necessarily talking just about meningitis—we expect them to come up with the right treatment, which involves another judgment and a great deal of uncertainty. Even if the diagnosis and choice of treatment are right, it may be that the treatment will, for one reason or another, go wrong.

Nevertheless, within the national health service, most people, most of the time and in most places, get very good treatment. Over the past 15 or 16 years, there has been a big reduction in mortality in hospitals, a big improvement in people’s recovery from treatment for a serious illness, and we have been catching up with some countries that had a better record than us. Despite all the criticism, general satisfaction with the national health service remains high. If people are asked what they think of the national health service, about 60% say it is pretty good. If they are asked how the NHS treated them or a member of their family, the percentage of those who are satisfied is usually in the high 80s or low 90s. Any political party or political leader would love that sort of satisfaction rating.

People working in the NHS have very demanding jobs and they need help in doing those jobs. The first thing we must do is try not to make their lives more difficult than they are already. We should ensure, for instance, that they are not in a decrepit hospital without enough beds and that the equipment they have is reliable.

Photo of Kevan Jones Kevan Jones Shadow Minister (Defence)

Does my right hon. Friend agree that one of the achievements of the previous Labour Government was the capital investment we put into hospitals? In 1997, for example, the hospital in my constituency was housed in the old workhouse, and we now have a brand-new hospital thanks to Labour. That has made a difference not just to patient care but to the working environment of the people we are asking to care for those patients.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras

That is certainly the case and applies to many parts of the country, including areas represented by Government Members.

I do not think any hospital has had more money spent on it than University College hospital in my constituency, the rebuilding of which, I freely admit, was authorised when I was Secretary of State. I understand that it is the hospital in this country from which one is least likely to come out dead. It is a good place that has modern and reliable equipment and is not, generally speaking, short of staff. It is quite clear that staff shortages in parts of the country have endangered the standard of care provided.

People’s pay and conditions are also important. The Cavendish report, produced only last week by a journalist for The Daily Telegraph, Ms Cavendish, stated that she regarded the pay and conditions of large numbers of people providing services outside hospitals to people who need them as disgraceful, shocking and a condemnation of our society. She is quite right.

One thing concerns me most, however. I remember when I first became Secretary of State for Health being telephoned by a very good friend who was then a professor in the medical school at Nottingham and said—I shall have to bowdlerise this—“For Lord’s sake, leave us alone. Do not reorganise; do not distract people from their usual jobs.” That is what too many Governments have done, including this one, but I do not want to go ranting on about it.

One thing I want to talk about is not mentioned very often. It became fashionable to say that the money must follow the patient and that we did not want to hand over big lumps of money to hospitals and other parts of the health service as that did not provide the right incentives. The only trouble is that as a result NHS transaction costs went up from 4p in the pound to what is estimated now to be between 12p to 15p in the pound. That is a lot of money—about £8 billion, £9 billion or £10 billion extra, just because of the new method of funding. If we want to release funds to help people who are being treated in the health service and who want to be treated there, to provide the buildings, equipment and staff, and to encourage the staff, we must think about the money being squandered on transaction costs. Unless we do something about that, it will only get worse under the new system.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West 5:58 pm, 17th July 2013

The Opposition often say that we need to learn lessons—in many ways, I agree with them—and so I intend to go through some of the lessons we can learn. I note that on the 65th anniversary of the NHS, Labour made cupcakes saying, “We love the NHS”, which prompts an interesting question: do we love the NHS—the institution—or do we love, care for and want to protect the patients it serves and respect the professionals who work in it?

I was also very perturbed yesterday by the venom in the denial of some—not all—Opposition Members. As I said then, it reminded me that Julie Bailey faced the same venom and aggressive denial in response to her mission to try to expose some of the truths at Mid Staffs. I am equally perturbed and disturbed that a lot of that venom is coming from two Labour party members locally, Diana Smith, who used to work for David

Kidney, and Steve Walker. I would very much like to know whether the Labour party will formally condemn those actions.

The shadow Secretary of State mentioned rewriting history, and I am also slightly concerned that there was a little bit of rewriting of history or confusion in that state of denial. I remind him that it was not him who commissioned Francis 2. He commissioned Francis 1, which was an inquiry of far more limited scope where evidence was given behind closed doors. He had every opportunity to commission Francis 2, and if he had done so the lessons he is now saying we must implement more quickly—and I appreciate speed is always of the essence—could have been implemented some time ago.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I would like just mildly to correct what the hon. Lady said. When I commissioned Francis 1, I said to Robert Francis that if he did not think he was receiving enough co-operation from witnesses in the first-stage inquiry and he came back to me wanting me to give him powers to compel, I would be glad to give him those powers. The second point the hon. Lady needs to bear in mind is that when he delivered his first report I told this House, in February 2010, that I would be commissioning a second stage report looking at the wider regulatory issues.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

That is very encouraging to hear post-event, but unfortunately it still leaves some questions as to why the Cure the NHS group was not able to go along and formally deliver the case studies of Bella Bailey at the Department of Health but instead had to go and see the former Secretary of State outside his constituency office—and for those who want to deny yet more evidence, that is on YouTube.

We have to ask why this review was not commissioned at the time if there were, through 81 requests, serious concerns raised. What did people have to hide? In 2009 Alan Johnson said fairly clearly that Mid Staffs was a one-off, but unfortunately we know from the Labour “lines to take”—which are in the inquiry so are in the public domain—that Labour knew there were 12 hospitals with equal or even worse mortality rates. That was denied, but, tellingly, that brief says Labour should try to avoid naming them. That stands in stark contrast to the approach taken in the Keogh report, which has been transparent in naming those trusts where there are problems. Unlike Labour, I do not think being honest about the situation prevents improvement; actually, I think it helps improvement.

Photo of Charlie Elphicke Charlie Elphicke Conservative, Dover

I congratulate my hon. Friend on making such a powerful speech. Does she agree that we have got to put patients first? If we put institutions first, and if we worry about staff and staff morale and how they might feel about things, we will inevitably slide in the direction of having a culture of sweeping things under the carpet and—dare I say it—covering things up. Unless we put patients first, we will not ensure there is a proper, sensible culture in our health service.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

I absolutely agree with my hon. Friend. I would draw a distinction, however, as I think many members of staff in the NHS want, and wanted, nothing more than to put patients first. I was slightly surprised that only two Opposition Members mentioned patients and patient safety in their contributions yesterday. That was very upsetting.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras

In reference to the point the hon. Lady made to the previous intervention, does she agree with Professor Keogh—a most excellent man—that there is a strong correlation between the extent to which staff feel engaged and mortality rates, thus indicating that caring about staff is absolutely crucial if we are going to care about patients?

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

I absolutely agree, although there is a distinction to draw between managerial staff, who I think have been leant on heavily to make their hospital look good, and the ground-level staff, many of whom have been battling over the last decade to be able to put clinical priorities ahead of management and political priorities.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

I am going to make progress, if I may.

I am surprised when many on the Opposition Front Bench talk about the welfare of staff, because one of the things Labour did that was so disastrous was take the medical royal colleges out of inspections. That happened after one hospital in particular was found to be lacking. Alan Milburn at the time—in the early 2000s—removed the medical royal colleges from the inspection regime, and did so perhaps, we have to ask, because they might come up with some very unpleasant truths. I am delighted that the Secretary of State is looking to reverse that decision in respect of those who know and will give Governments of all colours a good kicking if things go wrong.

There has also been, unfortunately, a culture of cover-up—I would love to be proved wrong on this; there is still time, there is information that I am still seeking, and anyone can come to me with it—about the three reports that were commissioned on the 60th anniversary of the NHS. The right hon. Member for Leigh shakes his head but I would very much like to meet him to see whether he can show me the minutes of the meetings which he must have attended, at which these reports were discussed. [Interruption.] I will make progress while he talks at me from the Opposition Benches.

It is ironic that on the 65th anniversary we have cupcakes. On the 60th anniversary there were three reports which warned, I remind Members, of a culture of fear and compliance—that sounds familiar; hitting the target and missing the point, which also sounds familiar; and inadequate regulation and inspection. Goodness me, doesn’t that sound familiar? The reports were exhumed only after freedom of information requests. I have put freedom of information requests to the Department of Health which, oddly, have been obstructed. I seek the help of the Secretary of State and of the shadow Secretary of State, if he would like to set the record straight, in seeking information. Who was present at those meetings where those reports, which cost the taxpayer £500,000, were discussed? They were by international experts, including Don Berwick, whom we are now putting at the centre of our NHS on the zero-harm strategy.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

I am terribly sorry. I will make progress.

I would also like to set the record straight on who knew what about hospital trusts. The right hon. Member for Leigh says that he took astute action. He knows, because I have the e-mails, as he does, that he was written to by Professor Sir Brian Jarman about 25 trusts about which he had concerns. He said he was concerned that the CQC was not doing its job. Seven of those were investigated by Sir Bruce Keogh. Fifteen of those trusts were in marginal seats and one, as he will know, was in the constituency of the right hon. Member for Leigh.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

That list, when Brian Jarman gave it to me, was immediately referred to the CQC. Within weeks, six of the trusts, I think, on that list were registered with conditions before the general election.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

The fact that the very same trusts appear in the Keogh report and have not resolved their problems proves that we have suffered a legacy issue. Those reports are still relevant.

The then Secretary of State referred those trusts to the CQC, which we now know he was leaning heavily on. We know that people were saying that the aim of the CQC’s operation was that no bad news should come out. The lessons that we need to learn about how to avert risk and to care for patients is to return to the specialist, honest medical analysis and inspection of hospitals that will give all Governments some uncomfortable truths. This party wants to hear uncomfortable truths. We do not want to smother them.

Labour has presided over a culture of bullying, threatening and aggressive denial, which we sometimes see in the Chamber. We will not be bullied now. The truth is out. Finally, patients and professionals struggling to care for those patients will not be stifled under a saccharine sickly-sweet cupcake icing which says, “We love the NHS”. We have seen in so many tragic cases that that love has been lethal.

Photo of Derek Twigg Derek Twigg Labour, Halton 6:07 pm, 17th July 2013

No one would disagree that if there are problems with standards or care in any hospital or any part of the health service every effort should be made to bear down on those problems and deal with them, whether that is by supporting the leaders or clinicians who are responsible for it, or removing them, if necessary. We must bear down on problems and continue to improve standards. Everybody wants to see that. When we are trying to build on the improvements of the Labour Government, it does not help to undertake at the same time a reckless reorganisation of the NHS, which has taken a massive amount of time and effort, cost at least £3 billion and opened the door to privatisation. That has caused chaos in the health service.

I talk to staff and managers regularly. There is massive pressure on them. They feel completely uncared for. They feel that no one is bothered. They are told to do things for which they do not have staffing. They have to maintain standards, which is very difficult because of shortages of staff and because of the pressures on them.

Photo of Andrew Smith Andrew Smith Labour, Oxford East

Among the many other dangers of privatisation, is not one particularly relevant to the debate today the fact that transparency will be lost because of private commercial organisations’ unwillingness to share information and be transparent?

Photo of Derek Twigg Derek Twigg Labour, Halton

My right hon. Friend makes an important point. That is one of the things that we explored during the Committee stage of the Health and Social Care Bill and of course we got no answers. The then Minister, now Minister of State, Department for Transport, Mr Burns, said that as time goes on the NHS will be more open to the competition laws of both the EU and the UK. That is the real story here, and we will not have that transparency. That is a major part of the problem we are having to deal with.

No matter what statistics we are talking about, losing a friend or loved one is a massive human tragedy that affects everybody. We want to do all we can to reduce the number of early and preventable deaths—that is absolutely right—and put patients’ interests and those of families first. Given what we have heard in the last day or so, one would think that we somehow left an NHS in crisis—an NHS that was not delivering—yet when we left office it had the highest satisfaction rate in history. We had the lowest waiting lists in history and massive reductions in early deaths from cancer, coronary problems and so on. We also saw massive increases in doctors and nurses. We hear this Government talking about increasing the number of doctors, but when did those doctors start their training? They started under Labour.

To give an example, so that we can be a bit fairer about the situation, the Commonwealth Fund produced an international health policy survey in 2010 that looked at 11 countries—and guess what? The UK health service came out best. Just as an example, when those on above average incomes and those on below average incomes were asked whether they were confident that they would receive the most effective treatment if sick, the best results—95% and 92%—were in the UK. That was an international survey. Another question was whether people were confident that they would receive the most effective treatment if sick—and guess what again? The UK came out on top, at 92%. That is the real picture of the NHS that we left behind in 2010—although it was not without its problems and challenges, because pressures were always building up.

I also noticed that pages 4 to 5 of the Keogh report say—this is an important comment that has not been looked at much in the press—the following:

“Between 2000 and 2008, the NHS was rightly focused on rebuilding capacity and improving access after decades of neglect. The key issue was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

That is where Labour made one of the biggest differences. I remember regularly having people write to me back in the late 1990s and the early 2000s about having to wait over two years for an operation. People were literally dying because of that. Addressing that was one of the biggest gains that Labour made.

The Secretary of State has now left the Chamber, but earlier I raised with him the issue of mortality. He refused to correct the record. He said that there had been a “slight” improvement by 2010, yet Professor

Keogh talks about a 30% improvement in mortality in all hospitals, including those that have been under investigation. That is not to say that those hospitals should not be doing better, but he was talking about all hospitals.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health)

Professor Keogh’s report also shows that although mortality has dropped by 30% in all hospitals, it has dropped by between 30% and 50% in the 14 hospitals subject to the Keogh review. Although those hospitals are still outliers, the drop has been greater at those 14 hospitals.

Photo of Derek Twigg Derek Twigg Labour, Halton

My hon. Friend makes a strong and important point. I referred earlier to figures from the Library, but those figures are from the NHS. Just to repeat, the rate of deaths per 100,000 within 30 days of a non-elective hospital procedure in England was 4,850 in 2001-02 and 3,684 in 2010-11. That is a significant drop, so I hope the Secretary of State will correct the record, change his view that there was a “slight” improvement and confirm that was a significant improvement, because that is what the evidence from his own Department says. Why is that important? It is important for a number of reasons. It is important to see improvements, but we should also bear in mind that the fall from 2001 took place against a massive increase—4 million additional admissions—in the number of people admitted to hospital. It is also important because people want to see continual improvements and be assured that their relatives and friends are receiving the best possible treatment.

In the short time I have available, I want to talk about a couple of local issues. Staffing plays a fundamental part in regard to risk. Many hospitals are having real difficulty with staffing at the moment, and many more will do so. I will say more about that in the context of my own hospital in a second. We need to address the problem, and the mix of staff is also a factor.

The Warrington and Halton Hospitals NHS Foundation Trust serves my constituency. We have been told by the chief executive and the chair of the board of governors that our hospital will run out of money in about 18 months’ time. It has already had to make savings in staff numbers of about 200, and implement a £7 million cut. The hospital will be unsustainable in that situation. What are the Government going to do about that? It is a foundation trust, and as far as I am aware, there are no significant performance issues. I get complaints about the different hospitals, but it is no worse than any of the others. It will run out of money, however.

My hon. Friend Mr Watts has mentioned the St Helens and Knowsley NHS Trust. The Whiston hospital was rebuilt under Labour’s plan to rebuild hospitals. We replaced Victorian hospitals—and workhouses, as in the case of the Whiston—with more than 100 new hospitals. The deal on the Whiston hospital under Labour involved a private finance initiative, with the difference being paid for by the two primary care trusts. This Government have got rid of the PCTs, but they have still not put in place a way of funding the hospital on a long-term basis. The uncertainty continues, despite debates on the matter in this place and meetings with Ministers, and we still do not know what is going to happen. It is an excellent hospital with brand-new facilities, but it is facing a real challenge. We need the Government to make decisions about hospital funding, to ensure that it and others can continue; otherwise, many more hospitals will get into difficulty.

Photo of John Pugh John Pugh Liberal Democrat, Southport 6:16 pm, 17th July 2013

This debate is notionally about managing risk in the NHS, but it is actually about reputational risk for Secretaries of State. I genuinely feel sorry for all Secretaries of State, because it is very unlikely that nothing will go wrong on their watch. It is unlikely that the entire NHS will perform optimally, that there will be no significant variation in performance and that the NHS will deliver an absolutely perfect service.

Secretaries of State have to get a whole raft of things right. They have to get the funding, the appointments, the regulation and the legislative framework right, and when something goes wrong, they have to get the troubleshooting right as well. They also have to keep a whole raft of health professionals happy, including pharmacists, dentists, GPs, nurses, midwives and health visitors, as well as patients from the age of nought to 90. Surveying that task, I think we have to agree that it is mission impossible.

The two things that will afford a Secretary of State the most protection are, first, good regulation and inspection, and secondly, the professional commitment, engagement and dedication of health professionals including doctors, nurses, ambulance staff and, dare I say, managers—or, as they are they are sometimes referred to in this place, bureaucrats. I think we all acknowledge the need for good management in the NHS.

We have been appallingly badly served by the regulators. Let us take the Care Quality Commission—where do I begin? And what about Monitor? Yesterday, we had the statement on the Keogh report. Before that, we have had statements on Mid Staffs and Morecambe Bay. Although not many people have acknowledged it yet, the majority of the hospitals involved are foundation trusts, and were inspected by Monitor. The majority were given a positive, green risk rating in 2010. What does that tell us about foundation trust status and its benefits? What does it tell us about Monitor, and the CQC, as regulators? Bizarrely, we seem to have given those bodies, which do not seem to be wholly competent, an increased role in the health service over the past couple of years.

The only other protection from serious embarrassment that is available to a Secretary of State is the fact that the NHS survives most things. There is a huge amount of professional commitment from NHS staff. Ironically, however, that can be undone by unwise, poor, tick-box, target-chasing and clinically unjustified regulation. That applies across the NHS and, I would suggest, across public services as a whole. Regulation and inspection, if ill-advised, can undermine professional standards, with disastrous effects for individuals and institutions. Certainly, those who know anything about Ofsted will know that Ofsted can do that, and I am sure that the CQC has done it. The Government have also done it through distorting priorities or simply by inspecting the wrong thing. The truth is that we need to work more with the grain of professional judgment, to listen to it more and not assume that it is always a self-serving producer interest. We can encourage the best and challenge the worst, without disparaging professional ethics.

Recently, the Government have got themselves into a sort of enviable no-lose situation with regard to the public services. If policies are supported by professionals, it proves that the Government are right. If on the other hand policies are opposed by professionals, it proves that the Government are challenging the provider interest and are right again—so they can never be proved wrong. My simple point—it is the only one I really want to make—is that if Governments were not always so easily persuaded that they were right, we would get a whole lot less wrong.

Photo of Ann Clwyd Ann Clwyd Labour, Cynon Valley 6:20 pm, 17th July 2013

As on six previous occasions, I shall read from testimony showing a lack of care and compassion from the 2,500 people who sent letters and e-mails to me.

The family of an 89-year-old patient wrote:

“During our daily visits, we had to locate a cup from the kitchen on the ward in order to give her some fluid. She never had a drink of any sort within reach. This resulted in severe dehydration, which was apparent by her sunken eyes, dry, scaly skin, fatigue and her unquenchable thirst when we provided her with drinks. The staff informed us that she was not eating but we found she would eat any food we brought in for her. Whilst in bed the staff neglected to move her on a regular basis and this resulted in circulatory problems and ultimately necrosis of both feet. She also developed many infections…the wound on one heel was so advanced that the bone was visible.”

A man whose son suffered further brain damage due to lack of care said:

“He was left lying in his own urine, faeces, etc. He was left without fluids for over 12 hours then he had a huge seizure. The doctor would turn up at 5 o’clock stating ‘What’s the plan for today?’ when the day was clearly over…I witnessed nurses allowing drugs and feed to go to the floor…the floor was in such a state my feet were sticking to it. You can’t blame the cleaners for MRSA!”

A woman writes about her father’s death in hospital:

“I used the term ‘conveyer belt to death’ at the time we lost our beloved dad. On that chaotic Friday afternoon, when all the Consultants and senior staff are dashing off for an early week end finish, a poor young doctor was pushed into our path by one of these Consultants from the palliative team and uttered the immortal words that will stay with me—“Is Tuesday OK?”…I only twigged later that night that that was the date to cancel any care and pull the plug.”

A woman writes of her father’s experience in hospital:

“I’ve tried to find out what he’s eating and how much but no one seems to know and the nursing staff just tell me they have too many plates to clear to remember who was eating what. My Dad is wasting away in front of my eyes and they just keep telling me they’re too busy to help. My Dad is 76 and he has always been fit and well but I’m fearful now that he will never come home from hospital alive.”

Another woman wrote:

“Having continually pushed for the best care available during his time there, it seemed that complaining wouldn’t make any difference, other than making me relive every humiliation, discomfort, stupidity and indifference…My father spent a month in hospital, and he said it was worse than his experiences in the Second World War…We watched one man fading away, naked apart from a soiled nappy, in full view of visiting families.”

The wife of a whistleblower wrote:

“My husband was a senior nurse who recorded what he considered to be gross ill treatment of patients to his senior Consultant…he was subjected to prolonged bullying campaigns and subjected to pseudo disciplinary procedures. He was supported by the RCN who managed to keep him in his job…To cut a long story short, after six years of abuse, stress and fear my husband suffered a major stroke while working at the hospital. He was later subjected to a vicious attack” by the management

“at his back to work interview. He retired from the NHS on medical grounds. He was 46 years old. He lost the job he loved. The NHS lost a highly skilled super intelligent practical nurse who loved his patients and worked hard for them. His colleague who supported him lasted a bit longer but was also forced into retirement after her health was destroyed by bullying because she also witnessed and reported the abuse of patients”.

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

The right hon. Lady is telling us some very compassionate and emotional stories. Does she feel that the voice of families, which she has illustrated very well, needs to be heard more by management and staff, and does she feel that the process should be improved to enable that to happen?

Photo of Ann Clwyd Ann Clwyd Labour, Cynon Valley

Many people are afraid to complain. Some complain many years later, and some never do so at all. It must be made easier for people to complain.

Photo of Glyn Davies Glyn Davies Conservative, Montgomeryshire

I was reluctant to intervene when the right hon. Lady was giving all those examples, but this seems to be a natural break. I share her huge concern about end-of-life care in hospitals, and she may share my concern about the Government’s announcement this week that the Liverpool care pathway will end this year. I hope that the Government are clear about what will replace it, and that we do not end up with confusion about responsibilities in hospitals, which could lead to less dignity and care as people reach the end of their lives.

Photo of Ann Clwyd Ann Clwyd Labour, Cynon Valley

I thank the hon. Gentleman for making that point. My next piece of testimony comes from a man who wrote this about his mother’s death in hospital:

“'My mother died under unspeakable conditions. The treatment she received, being deliberately dehydrated to death, on the so called ‘Pathway’, and total lack of sedation resulted in a death of anxiety, pain and total lack of dignity, which I personally witnessed.

The callous attitude of the staff beggared belief. My mother suffered incredible levels of neglect and abuse. We initiated a complaint, resulting in several distressing meetings. The whole procedure was to no avail as we only received platitudes of regret resulting in written statements of denial of any lack of patient care”.

Another man wrote:

“I left my wife with the assurance from nursing staff that she would be given a bath. I found her the next day some 15 hours later in her own excreta and vomit. Her face had been wiped clean. Nothing else. I was told the hoist was not working and that the bath was not plumbed in, and, in any event, nursing staff did not have the time to bathe her. Having found the equipment in perfect working order I bathed her.

I was caring for a fragile lady. I couldn’t make a complaint, I was frightened because my complaining would upset her and more uncomfortably, I had no trust in the nursing staff. Complain and how much worse could the callousness be? I took her home saying nothing. I'm still ashamed”.

Another man wrote this about his treatment for a punctured lung:

“My drip was not changed for six days, my chest hair that was shaved was left to fall under my bed and not cleaned up properly. I was never washed and in the end went by myself to the shower past the nurses station pulling my drip trolley—no one helped or worse enquired what I was doing. Water was taken away very early in the morning and not returned for at least two hours although there was obvious chatter coming from the nurses station”.

All the testimonies that I have read out come from Wales.

Photo of Phillip Lee Phillip Lee Conservative, Bracknell 6:28 pm, 17th July 2013

The title of the debate, “Managing risk in the NHS”, is very important. Indeed—although this may not be a topic for today—we ought to start thinking about the whole concept of risk and what patients will accept in terms of risk, especially given that everyone now has access to information via the internet. Invariably, the first thing someone puts into Google is the thing they are least likely to be suffering from as a consequence of the symptoms they are experiencing, so it is extremely important that risk is discussed much more with the patient population. As Frank Dobson said, it is extremely difficult to be a GP and to try to manage the demands being placed on the health service when people are coming in thinking that their headache is a brain tumour and so on.

It is particularly appropriate that I am speaking in this debate, because today the Care Quality Commission has published a report on Heatherwood and Wexham Park Hospitals NHS Foundation Trust. I am surprised that Fiona Mactaggart has not taken the opportunity to speak in this debate as a consequence. The report highlights significant concerns about the trust and the care of patients. None of the concerns was news to me: I approached the then Health Secretary about them in June 2010; I spoke to Monitor, whose chief executive told me, remarkably, that he had no concerns whatsoever and nothing had come across his radar about the trust; and I also spoke to Cynthia Bower in September 2010 about them. I say that because Monitor and the CQC were clearly not fit for purpose and doing their job of finding out what was wrong with hospitals.

I recognise the current Secretary of State’s desire to have a chief inspector of hospitals, and I wholeheartedly support him on that concept. However, I counsel colleagues on both sides of the House that if we start looking properly at the performance of hospitals, we will, judging by the list of experiences that Ann Clwyd has just shared with the Chamber, have plenty more stories to deal with about hospitals, and how they fail or are failing.

I wish to concentrate primarily on legacy and the genesis of these problems, which probably blight both parties. A hospital does not suddenly become a problem in the space of a couple of years; that can occur over a number of decades. The problem we have in this country is that a large number of our hospitals are not fit for purpose. There is a legacy of poor location, not only because the land was often bequeathed, but because the buildings are often not fit for purpose. That is the particular problem at Heatherwood, and with its theatres, as was highlighted in the CQC report.

There is also a legacy in respect of the district general hospitals in general. They have had their day and we do not need them any more; we need regional specialist hub hospitals such as the one I have been proposing for the Thames valley for the past three to four years. I say that because if we are trying to provide care, it is incredibly difficult to mitigate risk when the theatre is not fit for purpose or when the hospital cannot be staffed appropriately. Labour Members have made much mention of nursing numbers, but the issue is much bigger than that; it is about the quality of the clinicians. Most clinicians have to specialise and sub-specialise, and the only way in which we will be able to provide the very best care in the 21st century is by having fewer acute hospitals. All the royal colleges share that opinion; I am not cornering that market. The flip side, however, is that we will have more community hospitals and more community care, which can only be a good thing.

If I were allowed to advise Members, I would tell them to be cautious on the issue of end-of-life care, because it will be extremely difficult to provide that in an increasingly ageing society. We are going to have some very difficult decisions to make for people in their 90s and for people over 100. There is no easy solution to this. The Liverpool care pathway was probably an honourable approach to try to take. I am not saying that it was perfect, but there was a desire to do the right thing in its implementation.

The reconfiguration is necessary and, for it to be appropriate, it will need cross-party support. We are not going to get anywhere by trading insults and taking political positions over various hospitals. Quite a few hospitals are not fit for purpose, with some in Conservative seats, some in Labour seats and some in marginal seats. If those of us who are interested in this topic truly want to improve care for all, we really need to remove party politics from the reconfiguration debate and engage in a cross-party discussion about where these hospitals should be. If we did that, if we managed to build some new hospitals—I suspect that we will have to build quite a few, because, as I said, the problem with a number of established hospitals is that their locations are inappropriate, as is certainly the case in my part of the world—and if we could come to a consensus and some agreement on this, we would be bequeathing to future generations a hospitals sector to be proud of. We do not have one to be proud of, however. We heard that mortality rates have been going down, but of course that is the case, because we are getting better at medicine, but with that come challenges regarding the end of life.

Photo of Charlotte Leslie Charlotte Leslie Conservative, Bristol North West

Does my hon. Friend have any information about how Britain’s reducing mortality rate compares with that of comparable European countries?

Photo of Phillip Lee Phillip Lee Conservative, Bracknell

I do not have such information to hand, but it would be interesting to compare our mortality rates for various conditions with those of Germany, Holland and France over the past seven to 10 years to determine whether there has also been a decline in those countries. It is difficult to claim that it was just the investment of money that led to reduced mortality rates in this country. I do not rule out the fact that the investment was a factor, but I suspect that the decline was due to advances in medicine and technology, and indeed in the skill base of consultants.

If we reconfigure, consultants will have a larger throughput of patients. It is interesting to note that Tameside covers about 175,000 patients—not enough—that Basildon and Thurrock covers about 300,000 or so, and that Mid Staffs covers about 225,000. Hospitals should cover a minimum of 500,000 people, if not 750,000, if they are truly to deliver the best acute and surgical care. The staff, especially the consultants, will want such a throughput of patients so that they can maintain and enhance their skills, and thereby improve mortality statistics. I therefore conclude by begging the Government and the Opposition to take the party politics out reconfiguration so that we can secure a hospital sector of which we can be proud for the next five decades.

Photo of Valerie Vaz Valerie Vaz Labour, Walsall South 6:36 pm, 17th July 2013

It is always a pleasure to follow Dr Lee. I do not think that hon. Members have had a chance properly to mention that the NHS is 65 years old.

We now have two figureheads atop the NHS: the Secretary of State and the chief executive of NHS England. Hon. Members might have missed the change of name from the NHS Commissioning Board to NHS England. Such is the power of the chief executive that he neither had to come to Parliament nor to deal with elected representatives to achieve that. The two of them sit there like Laurel and Hardy, whose catchphrase was, “Here’s another fine mess you’ve gotten me into.” We know there is a mess, as there is a host of ongoing reviews.

Let me start by referring to the Francis report, which was produced by a leading QC who started his work in 2009 after being picked by my right hon. Friend Andy Burnham, so that was something he got right. Some £10 million later, after sifting the evidence and hearing bereaved people give their testimony, Robert Francis produced a report with 290 recommendations. At the time, it appeared that they had been accepted in full, but all is not as it seems, because apparently there needs to be a review on its implementation.

Yesterday, we received Sir Bruce Keogh’s thoughtful review. It is actually a model report, as it gives clarity on what needs to be done. The Secretary of State mentioned Don Berwick’s report on the Francis review, which is due in the autumn. Camilla Cavendish has reported on health care and social care assistants. My right hon. Friend Ann Clwyd and Tricia Hart will review how patients make complaints, although no date has been given for when that will report. Sir Bruce Keogh is busy again, as he is producing a further report on a plan for vulnerable older people, which I think is also due in the autumn.

You would be forgiven for thinking that that was the end of it, Mr Speaker, but that is not quite the case. The chief executive of NHS England announced to the Health Service Journal—not to the Secretary of State nor to Parliament—that he would do some work to determine what NHS England’s strategic direction might be. One would have thought that he would already know, and the process seems somewhat late given when the body was set up. He told me that the cost would be £3 million over three years, but how many doctors and nurses would that buy?

What has been the response of the Secretary of State to date? Urgent care boards and chief inspectors—PR and an extra layer of bureaucracy. The Health Committee heard evidence that urgent care boards were the management that was removed by what happened to the strategic health authorities. What are the costs? The Treasury has already clawed back £3 billion from the

NHS. According to the National Audit Office, the efficiency gains of £5.8 billion that were made in the first year were a result of reducing the tariff to providers and the public sector pay freeze, but how long can that carry on?

The NAO has published interesting statistics following the passage of the Health and Social Care Act 2012. The reported cost of the reforms was £1.1 billion. The Secretary of State told the Health Committee that he had seen—he did not know—a figure of between £1.5 billion and £1.6 billion. Professor Kieran Walshe has put the figure at £3 billion.

The NAO said that of the 170 organisations closed down, 240 have been opened, and 10,094 full-time equivalent staff have been made redundant. It is a shame, when there is an underspend of £3 billion, that the College of Emergency Medicine is crying out for extra emergency doctors and consultants, and at least half a million pounds is spent on locums in A and E, and all before we have even looked at integration.

Many have endorsed what is rapidly becoming known as the Burnham plan, including Mr Dorrell. The Health Committee has seen the work at Torbay, which was piloted in 2004-05—by the previous Government, incidentally—but we were told that the Health and Social Care Act could affect the way it works.

I want to ask the Secretary of State to do something fairly useful: ask someone at the Department of Health to pull together and publicise best practice from across the country. The Health Committee heard evidence that some of the A and E hospitals had got it right by moving elderly people directly to consultant geriatricians.

Finally, it is very easy for those of us who are exposed to the world of NHS structures to say how we can fix it, but Robert Francis took evidence from those who use the service directly on how they came across the inaction and indifference of a large institution. Sir Bruce Keogh has done the same with his report. They talked directly to those on the front line and those who use the service, not just those in the boardroom. They are the ones who should be listened to—all those who work in the NHS and have to provide a service when their pay is frozen. The people who use our NHS want professional people who are competent at their job caring for them when they are at their most vulnerable. Only if we listen to them will we be able to wish the NHS many happy returns in future.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People) 6:41 pm, 17th July 2013

It is a pleasure to follow my hon. Friend Valerie Vaz in this important debate. As my right hon. Friend Frank Dobson and my hon. Friend Derek Twigg said, over the past three years the biggest risk to NHS patients and taxpayers has been this Government’s decision to force through the largest back-room reorganisation in the NHS’s history at the same time it faces the biggest financial challenge of its life.

We left government with the lowest ever waiting lists and the highest ever patient satisfaction, but we knew that further changes were essential to improving the safety and quality of patient care and getting better value for taxpayers’ money. And we had a plan to make it happen in every region in England, through Lord Darzi’s report, “High Quality Care for all”, which set out precisely how we would achieve the kind of reconfigurations of hospitals that Dr Lee mentioned and precisely the kind of integrated services focused on prevention in the community mentioned by my right hon. Friend Andy Burnham and my hon. Friend the Member for Walsall South. But Ministers scrapped those plans and instead forced through a top-down reorganisation that not only wasted billions of pounds, but meant that local services lost grip and focus precisely when they were needed most.

The Government were repeatedly warned about the risks of their Health and Social Care Bill. While they have refused to publish their own national risk register, up and down the country local NHS organisations did the job for them. Those local NHS risk registers warned that front-line staff would be cut. They were right: over 4,000 nursing posts have been lost under this Government. They warned that specialist cancer networks would be scrapped, and they have, along with Labour’s stroke networks, both of which were vital to improving the quality of patient care. The local risk registers also warned that structural upheaval and fewer front-line staff would destabilise winter planning and mean more patients waiting longer in A and E. That is precisely what has happened.

This Government have presided over the worst A and E crisis in a decade. At its height, 100 trusts failed to meet the four-hour A and E target. Even during spring, more than half of all hospital trusts missed the target. The risk to patients is not just that they have been left waiting for hours in distress and pain on trolleys or in the back of ambulances. As Sir Bruce Keogh’s excellent review states,

“over 90% of deaths in hospital happen when patients are admitted in an emergency rather than for a planned procedure”.

He goes on to say:

“The performance of the majority of the trusts was much worse than expected for their emergency patients.”

He is right. At the end of last year all 14 of those trusts were missing this Government’s lower A and E target, yet under the previous Government all 14 were meeting our higher A and E target.

Instead of getting to grips with the real causes of the A and E crisis so that they can deliver real solutions for patients, the Government have consistently sought to score political points by blaming the 2004 GP contract. [Interruption.] The Secretary of State says from a sedentary position that that is what the evidence says. Well, NHS England, the NHS Alliance and the NHS Confederation beg to disagree, to name just a few. They say that the real causes are primarily that more very elderly, sick patients are ending up in hospital and getting stuck there because of pressures on social care budgets, and that there are not enough services for specific groups of patients such as those with mental health problems and drug and alcohol addiction.

Ministers’ sheer incompetence in introducing the NHS 111 phone line has compounded the pressures in A and E. They were repeatedly warned, by the Royal College of Nursing, the British Medical Association, the Ambulance

Service Network, NHS Direct and potential private providers, about problems with their rushed roll-out, but they ploughed on regardless. The result was patients left hanging on the phone or waiting hours for call-backs, more ambulances being sent, and more patients ending up in already struggling A and Es. A report on this fiasco by the NHS Alliance, which represents primary care providers and commissioners, says that

“providers were put under unprecedented pressure by the Department of Health to meet their go live dates even if...they weren’t prepared”.

They say that the Government’s contracts focused more on cost than quality, yet they have disgracefully ended up failing on both.

We now face the real risk that the Government will fail to put in place many of the key changes that patients and the public desperately need. It is right that the Government are looking at the training of nurses throughout the NHS. I have no doubt that Sir Mike Richards will be an excellent chief inspector of hospitals. However, regulation happens after the event, whereas we need to focus on preventing problems from happening in the first place. That means having clear lines of accountability and responsibility from the bedside to the boardroom. It means listening to patients and the public. It means having a strong voice for local Healthwatch bodies. Hon. Members will know that up and down the country those have been very slow to get up and running and have very few staff. The task put on to them—to make sure that they are a strong voice for patients and the public—will be extremely difficult to carry out.

The Government are missing out on three key issues that have repeatedly come up in this debate. The Keogh review found time and again that staff shortages in the 14 hospitals with higher mortality rates are a real risk to the safety and quality of patient care, as did the Francis inquiry into the appalling failings at Mid Staffs hospital. That is why Francis makes very clear recommendations about staff numbers. The Secretary of State would not take an intervention from me earlier, so I will tell him what I was going to say now. Recommendations 22 and 23 in the Francis report say:

“The National Institute for Health and Clinical Excellence should” set out

“standard procedures and practice” and those should include what each service

“is likely to require as a minimum in terms of staff numbers and skill mix. This should include nursing staff on wards, as well as clinical staff.”

The report also says that

“no unregistered person should…provide…direct physical care to patients” and that this

“should apply to healthcare support workers”.

We tried for many years to improve their training, but without their being registered so that it could be guaranteed that they had the training required, it was not possible to do so. I called for this back in 2001, before I became an MP. The same arguments were being made then. We have not made progress and we need to do so now.

Finally, Francis says there should be a statutory duty of candour on individual registered staff as well as providers, yet the Government are dragging their feet on all those key recommendations. As Peter Walsh, the chief executive of Action against Medical Accidents, said yesterday,

“ministers are still refusing to accept key recommendations such as minimum staffing levels for wards and regulation of healthcare assistants.”

He also said that he hoped that Sir Bruce Keogh’s report will change the Government’s mind, and Opposition Members agree with him.

Government Members have made unfounded accusations that Labour Members covered up problems in the NHS, but our record proves that we did the precise opposite: independent inspection of the NHS for the first time; national data published on heart and stroke care and hip and knee operations for the first time; patient choice of hospital enshrined for the first time; and, far from ignoring mortality rates, it was the Labour Government who published them on the NHS Choices website for the first time.

Government attempts to smear former Ministers are shameful, but the real tragedy is not the cynical, political agenda being pursued by the Conservative party; it is that over the past three years the Government have put the NHS through risks that could have been avoided and they are failing to put in place the real changes and reforms that patients and the public need. I commend the motion to the House.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health 6:51 pm, 17th July 2013

It is a great pleasure to rise to speak in support of the amendment tabled by my right hon. Friend the Prime Minister.

Both sides of the House believe in our NHS, the staff who work in it and the care they provide for patients. I am also sure that both sides recognise that, in the wake of the Francis inquiry and yesterday’s report from Sir Bruce Keogh, the 65th year of the NHS has been its most challenging and that we need to face up to those challenges.

This debate has had three key themes: the importance of the NHS, the staff who work in it and the care they provide for patients; the importance of making greater productivity gains in the NHS to improve care and make sure that we do more with our resources; and the importance of openness and transparency and the need to learn lessons from things that have gone wrong, so that patient care can be improved.

Back Benchers have made some high-quality contributions. It is always a pleasure to hear Valerie Vaz and Frank Dobson. Derek Twigg made a very strong case for his local health care services. I pay particular tribute to Ann Clwyd, who has done some tremendous work in looking at how we can improve the NHS complaints procedure. She read out a number of examples of things that have gone badly wrong, from which we need to learn lessons for the future. The work she is doing at the moment is hugely important and valuable, and the Government look forward to receiving her report shortly.

My hon. Friend Dr Lee highlighted some of the challenges with the existing

NHS estate and the need to modernise facilities and make some of the older buildings more fit for purpose to meet the needs of patients in the modern world. My hon. Friend Charlotte Leslie made a very brave speech. She spoke at great length—and rightly so—about the importance of involving the medical royal colleges in deciding how hospital inspection processes should be implemented and about the importance of clinical leadership and involvement in those inspections to help understand what good care looks like. After all, those colleges are centres of excellence in their fields and it is right that we listen to what they have to say.

My hon. Friend John Pugh made a particularly thoughtful speech. He called for good management and spoke of the need for good managers in the NHS. He also made the important point that, in all our debates on patients who have been let down, the regulators have often not played their part. That is why we need to ensure that the regulators continue to come to the table and that the improvements at the CQC continue. The regulators need to remain fit for purpose.

The problem with mandatory staffing ratios is that they would just provide another tick box that would not necessarily bear a relation to what good clinical care looks like. There is a clear difference between mandatory staffing ratios and appropriate staffing levels, as the Francis report indicated. We need staffing levels that reflect the needs of the patients on the ward. Those will vary from ward to ward and will change on a daily basis according to the needs of different patients. It is important that we consider the patients who are in front of the doctors and nurses on the day. It may not be nursing care that is needed, but care from other members of the multi-disciplinary team such as physiotherapists and health care assistants. That is why it is wrong to use mandatory staffing ratios as a measure of good care.

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

The point that I keep raising with the hon. Gentleman, other Ministers and the Secretary of State is that there must be transparency in the numbers. Ratios of 2:29 have been reported to me, which nobody would be comfortable with. My excellent local hospital puts information about staffing ratios on the boards in each ward. Does he not think that we should move rapidly to provide transparency on this matter? I am asking not for mandated ratios, but transparency so that patients and their families can see what the ratio is.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

The hon. Lady makes a very good point about the importance of having staffing levels that are appropriate to the needs of the patients. That is why NHS England is considering toolkits that will help hospitals to build the right care in the right place and at the right time for patients and to adapt care so that it is provided by the appropriate professionals, according to patient need.

The debate has rightly focused on transparency and openness. We have not got that right in the NHS since the Bristol heart inquiry, which took place under the previous Government. Both the Government and the Opposition believe that we need to support staff who feel that they need to speak out and that there needs to be greater transparency and openness. I believe that the steps that the Government are taking will make a difference. We are introducing a contractual right for staff to raise concerns and issuing guidance on good practice in supporting staff to raise concerns. We are strengthening the NHS constitution and have set up the whistleblowing hotline to support whistleblowers. We are also amending legislation to secure protection for all staff through the Public Interest Disclosure Act 1998. We are doing good work and it is right that we continue to do all that we can to support staff in raising concerns about patient care, where that is appropriate.

We must focus on improving productivity in the NHS so that we can do more with the resources that we have. As the Secretary of State outlined, that is about improving the technology in the NHS so that we can spend more money on care and free up staff time. If we use technology to better join up health and social care, staff will spend less time on paperwork and more time with patients, which will improve patient care.

It is important to consider the fact that there are higher levels of morbidity and mortality at weekends and in the evenings. There needs to be more consultant cover and out-of-hours cover at those crucial times to ensure that the service is more responsive to patients. The Government are addressing that.

In conclusion, at the beginning of this debate, Andy Burnham rightly highlighted the long-standing problems in our NHS. Although Labour is now talking about social care, it was the last Labour Government who cut the social care budget between 2005 and 2010. Although Labour is now talking about the risk register, the last Labour Government refused to publish it.

Photo of Rosie Winterton Rosie Winterton Opposition Chief Whip (Commons)

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put accordingly(Standing Order No. 31(2)), That the original words stand part of the Question.

The House divided:

Ayes 214, Noes 277.

Division number 67

See full list of votes (From The Public Whip)

Aye

No

Question accordingly negatived.

Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.

The House divided:

Ayes 276, Noes 212.

Division number 68

See full list of votes (From The Public Whip)

Aye

No

Question accordingly agreed to.

The Speaker declared the main Question, as amended, to be agreed to (Standing Order No.31(2)).

Resolved,

That this Housewelcomes the Government’s swift action in response to the Francis Report; notes the rapid establishment of reviews on key components of the Report’s findings, including the

Cavendish review on healthcare assistants, the Clwyd-Hart review on complaints and the Berwick review on patient safety; further notes the drive to improve standards through the appointment of a Chief Inspector of Hospitals, the introduction of Ofsted-style ratings and the recruitment of specialist hospital inspectors; regrets the Opposition’s continued refusal to support these practical measures to expose and improve poor care; welcomes the watershed decision to expose and investigate 14 hospitals with high death rates through the recent Keogh review; further notes the Government’s decisive action to drive improvements in these hospitals by placing 11 hospitals in special measures; and applauds the Government’s wide-ranging efforts to introduce greater transparency and accountability in the NHS.