Stafford Hospital

– in Westminster Hall at 11:30 am on 1st April 2009.

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[Miss Anne Begg in the Chair]

Photo of David Kidney David Kidney Labour, Stafford 2:30 pm, 1st April 2009

We are honoured to have you in the Chair as our watchful eye while we debate this very important subject for Stafford and its surrounding areas, Miss Begg. Sir Patrick Cormack asked me to say that he very much wanted to be here to take part in the debate, because many of his constituents look to Stafford hospital for treatment, but, as I speak, he is chairing the Select Committee on Northern Ireland Affairs in a meeting with the Secretary of State for Northern Ireland, so he is unable to attend. He wanted me to give his apologies.

The national health service told the people of Stafford and me that our hospital was good: the trust that managed the hospital told us constantly that the hospital was good, and the regulator told us that the hospital was good. Back in 2002, the regulator was the Commission for Health Improvement, and it said that in 2001 the hospital's rating was only one star and that it had weaknesses. In the following year, the rating went to two stars and, in 2003, to three stars. Intuitively, that looks like an improving performance year on year, but in 2003, the Commission for Healthcare Improvement ceased to exist and the Healthcare Commission took over—and in 2004 the rating crashed from three stars to zero stars. That was when the great big pile of papers before me, detailing the hospital's performance, started for the regulator and for Ministers.

I asked the regulator, "Is this hospital safe?", and in 2004, the Healthcare Commission's assurances were that the hospital was safe and had some good performances, even though it had some weaknesses, which were mostly to do with waiting times. In the years that followed, under the Healthcare Commission, the hospital's ratings appeared—again, intuitively—to improve year after year. In 2005-06, the rating was fair on quality, fair on resources. Fair means room for improvement. In 2006-07, it was fair on quality, good on resources; and in 2007-08, it was good on quality, good on resources. It looked like a hospital improving.

The commissioner of services from the hospital, the primary care trust, did not point out that anything was wrong; it went on commissioning services. The performance manager of the hospital, the strategic health authority, did not point out that anything was wrong; it went on performance-managing the hospital. Then the regulator of foundation trusts, Monitor, approved the trust's application for financial trust status just last year, after what it claimed had been a rigorous examination of the trust's leadership, management and governance arrangements. But all those different parts of the NHS told us wrong, and we have been left bewildered, furious and in no mood for anything other than the strongest and quickest action to repair the terrible damage that has been done. Patients who trusted the NHS as a friend and saviour were tragically failed and let down. The hospital's leadership, management and governance were not good. The hospital was not good.

We see now from the Healthcare Commission's report, following a year-long investigation, that many things were wrong at the hospital. Where the trust told us that there were four accident and emergency consultants, one was at work, one was off sick and the other two were not consultants but a grade lower. The junior doctors who were supposed to call out consultants when they were not on duty never did call them out, and doctors were called away from very sick patients to treat patients with minor conditions. Apparently, at busy times, receptionists with no medical experience triaged patients in A and E, and—the comment that hit me like a physical blow—nurses turned off heart monitors because they did not understand how they worked.

The report says that the causes of that behaviour were bad management and understaffing, but all that time there were no whistleblowers, there was no strike action by staff and there was no calling in of royal colleges or other outside representatives; instead, it appears that hard-working, loyal doctors and nurses tried their best to make systems work that we now know were broken.

The important consideration is the patients and the situation's effect on them. They go into hospital because they are sick or injured, and they hope for good care and treatment—perhaps a cure—their health restored or, in some cases, their life saved. What did some patients, their relatives and carers get instead? Where there should have been speedy and effective treatment, there was delay, more pain than was necessary and what the report calls "poor outcomes", which in some tragic cases meant death. This is shocking, heart-breaking stuff.

Photo of David Taylor David Taylor Labour, North West Leicestershire

Westminster Hall is full of MPs from Staffordshire, not unexpectedly, but John Moore-Robinson, the 20-year-old son of a constituent of mine, broke his ribs in a mountain biking accident and went to Stafford hospital's A and E department, which failed to detect that he had a ruptured spleen. He was discharged, despite being in pain and violently sick, and died not long afterwards, although he was not in the hospital at that time. Martin Yeates, the hospital's chief executive, wrote to John's parents after the inquest, saying that it was

"time to move on and put this behind you."

Will my hon. Friend reassure me, either himself or through the Minister, that those cases that will be individually examined will include those who were admitted originally and briefly to Stafford hospital but went elsewhere—back home to Leicestershire, in this tragic case—and subsequently died?

Photo of David Kidney David Kidney Labour, Stafford

I am really sorry to hear that story and hope that my hon. Friend will pass on the whole House's condolences to his constituents. I shall deal later with the offer that has been made for an independent review of case notes, but when I spoke to the trust's interim chairman, he said that it will extend to anybody who was treated in the hospital, because it will have records on them. My hon. Friend will be able to say to that family that if that is what they want, that is what they will get.

Photo of David Taylor David Taylor Labour, North West Leicestershire

I should have said that the case occurred in April 2006, right in the middle of that period when the assessment showed that the hospital was fair on quality, good on use of resources.

Photo of David Kidney David Kidney Labour, Stafford

It is perfectly reasonable for the family to want such an investigation and assurance. If I can help my hon. Friend, he only needs to get in touch.

Where there should have been tender care for patients, professional consideration and good basic nursing standards, some patients suffered poor care, and they and their relatives and carers were distressed instead of calmed by their experiences in Stafford hospital. The commission's report endorses the complaints of nearly 100 patients who went to the investigating team and told them of instances of poor care that they had experienced, including in hospital wards 10, 11 and 12.

The commission's report also states that the investigating team suspects that there was an outbreak of clostridium difficile at the hospital in spring 2006, and that it should have been reported to the authorities but was not. It is worth bearing in mind that C. diff is a life-taking infection. The report was thorough, but questions continue to arise about what happened and why, and that is why I called for a public inquiry in my first letter to the Secretary of State for Health, when the report was published, and in the main Chamber a week last Monday.

Photo of Joan Walley Joan Walley Labour, Stoke-on-Trent North

Given the genuine and widespread concern about the way in which the authorities have handled the matter, despite so many attempts by so many people to get answers about what happened, it is also my view that a public inquiry is really important. My hon. Friend has the backing of a large number of people who want him, as the Member dealing with constituency issues on this matter, to make that case as strongly as possible to the Secretary of State for Health and to the Minister who is here to respond to the debate.

Photo of David Kidney David Kidney Labour, Stafford

I am grateful to my hon. Friend for her support and hope that I do not let her down, either in this debate or afterwards. I want to look again at the argument, and ask the Minister to do the same, for the case for an independent inquiry.

Photo of Paul Truswell Paul Truswell Labour, Pudsey

I congratulate my hon. Friend on securing a debate on such a crucial issue. Besides the invaluable service that he is performing on behalf of his constituents who are directly affected by the catastrophic events at Stafford hospital, does he also appreciate that patients around the country want reassurance that what happened there will not and cannot be repeated anywhere else?

Photo of David Kidney David Kidney Labour, Stafford

It is for other hon. Members to look at the situation in their local hospitals. Perhaps, like me, they have looked at the independent performance ratings from the Healthcare Commission and felt reassured. As I have explained, twice in the history of my representation of Stafford, what looked like reassuring performance ratings over a period of time turned out to be worthless. Hon. Members should consider the situation in their locality.

I welcome the Secretary of State's announcements two weeks ago in response to this damning report: the announcement about the independent review of case notes; the appointment of Professor George Alberti to conduct an immediate review; the further review by the National Quality Board about picking up on early warnings; and the report by Dr. David Colin-Thomé, the national clinical director of primary care, about not only the performance of this primary care trust and this strategic health authority, but the position of those kinds of organisations throughout the country. Finally, I welcome the Secretary of State's announcement about disciplinary action against the chief executive of the hospital trust. I want to mention each of those things in a bit more detail.

With regard to the independent review of case notes, for many people—the relatives of loved ones who died at Stafford hospital—deep wounds have been reopened. The Prime Minister was therefore right to be concerned, two weeks ago, about individuals in turmoil because of their bereavement who are now unsure, or more unsure than before, about whether the deaths could have been avoided. The Prime Minister assured me on that day, at Question Time, that anyone in this situation who asks for help will be entitled to an independent review of their loved one's case notes. What progress has been made in the last two weeks in setting up the arrangements for carrying out those reviews? Will the Minister accept the absolute urgency of starting them as soon as possible, involving relatives fully in them and completing them as quickly as can be? Does he know how many requests have been made so far? I am sure he can appreciate that this process will mean a lot to families, who want emotional closure after the devastating news of the last fortnight.

Photo of Mark Fisher Mark Fisher Labour, Stoke-on-Trent Central

I grateful to my hon. Friend for giving way, because I understand that he is under such pressure. Although I agree with my hon. Friend—and constituency neighbour—Joan Walley about an independent inquiry and the review of case notes, does my hon. Friend Mr. Kidney not feel that what he is describing is a collapse of the regulatory system? Regardless of getting a better understanding of what has happened in the past through an independent inquiry, if we are to reassure people about the future—not just in respect of Stafford hospital, but hospitals all over the west midlands and in the rest of the country—it is necessary to review the whole regulatory structure and reshape it to ensure that such things cannot happen again.

Photo of David Kidney David Kidney Labour, Stafford

My hon. Friend makes a good point. As it happens, today is the day when a new regulator takes the place of the Healthcare Commission. We must all look to the Minister to explain what is different today from the situation yesterday. I will come back to that subject when making my arguments about an inquiry.

When Professor Sir George Alberti's review was announced, the Health Secretary explained to the House that Professor Alberti is probably the country's leading authority on A and E care. There was some concern in my constituency, and in my mind, about whether that might be too narrow a focus in respect of this hospital's performance, given that the complaints and findings in the report went wider than A and E care. That is why I pressed for access to all areas at the hospital. I am pleased that everybody agreed to that. I saw Professor Alberti and he said that he was going to go anywhere that his investigation took him in the hospital. I asked the Health Secretary at Health questions last week to confirm that Professor Alberti would do that, and he said that he would. I also asked the NHS foundation trust regulator, Monitor, whether that would be so, and in a letter to me this week, Bill Moyes, the chairman of Monitor, said:

"I have requested Professor Alberti to expand the remit of his review...I have specifically requested that his review also includes the care provided on the medical wards 10, 11 and 12".

That is an important concession by Mr. Moyes.

Photo of Janet Dean Janet Dean Labour, Burton

I congratulate my hon. Friend on securing this debate. I know how desperately concerned he is, as the Member of Parliament for Stafford. He will know that most of my constituents are served by Queen's hospital in Burton, but some from the Uttoxeter area attend Stafford hospital for treatment and they are concerned about the failings at that hospital.

The information sent to hon. Members by the Royal College of Nursing says:

"Nursing staff raised their concerns with the Trust both formally and informally. However, despite nursing staff completing numerous incident forms regarding the low staffing levels and the impact this had on the level of care these complaints were never acted upon."

How does my hon. Friend think that that should be addressed? Should it form part of the inquiry that he is calling for?

Photo of David Kidney David Kidney Labour, Stafford

Some things need to be sorted out much more urgently than a public inquiry and one of those things is the way that the trust is managed. I should like to deal with that in some detail, although I know that other hon. Members are waiting to speak, but let me try to get on. I assure my hon. Friend that I will return to that point.

Professor Alberti started work at Stafford last Wednesday and I understand that he will finish this month. The Health Secretary gave an assurance that Professor Alberti's findings would be reported to the House. Can I take it that if people in Stafford want to hear first hand from Professor Alberti about his findings, he will be willing to meet people in Stafford to explain them? That would be helpful.

The National Quality Board investigation will be about how best the system can pick up early warnings. That picks up on what my hon. Friend Mark Fisher said about regulation. I understand that that is a slightly longer-term investigation that will take until the end of the year to complete, but I am sure that it would be helpful to the whole House if the Minister confirmed what personalities are involved and what kind of work will be done.

I understand that the Dr. Colin-Thomé review about primary care trusts and the strategic health authority will be carried out as urgently as Professor Alberti's review and that it ought to lead to conclusions about why this PCT and this SHA carried on as normal when the situation at Stafford was clearly abnormal and that it will look at the lessons to be learned across the country from those findings.

On the disciplinary action that has been announced, we have a full and thorough report that is damning about the management. The chief executive is responsible for the management of the hospital. Even two weeks before the report came out, the chief executive produced a statement saying that he was stepping down from the trust, which, locally, we all took to be the equivalent of resigning and getting no more pay. In fact, he sat at home and continued to receive his pay and there was no consequence for him until the day the report came out, when the interim chairman suspended him on full pay. That is one more example of something being said that was not meant. The hospital's good money should no longer be given to that chief executive. I hope that the Minister will express the urgency that everybody in Stafford feels is necessary to bring to an end the payment to that chief executive for work at that hospital.

The crucial question that arises because of those events, that report and the things that are in train at the moment is whether, today, the hospital is safe. That is a really important question for my constituents. The report says that whereas the Commission had concerns about A and E care, it had no such concerns about elective care. It says that complaints about outpatient care fell over the period of the investigation and that the coronary care unit and the critical care unit are highly regarded. It says that from the outset of its investigation it made the trust make changes to A and E care, and that in February 2009 it returned unannounced to inspect those changes and found them working satisfactorily. It says that the hospital is safe. The report also says that an unannounced inspection of infection control last autumn found complete compliance with the hygiene code for combating infections. All that is reassuring, but there are still complaints.

A week last Monday, I spoke in the House and asked for an urgent debate. I said that when I returned to my constituency at the weekend I received continuing complaints about care at the hospital. Last weekend, I visited a constituent at home who had complaints about nursing care in February 2009. Whatever improvements have taken place in the past year, everyone must agree that there is still more work to be done to restore public confidence in Stafford hospital.

A good organisation will try to address complaints straight away, and to put matters right while it can. A good organisation will review all complaints to learn lessons for the continuous improvement of its future work. Stafford hospital was not a good organisation, because the report tells us that it did not act on complaints about its services and did not learn lessons from complaints. In my meetings with the trust throughout that period, it told me that it was doing those things when it was not. That was the case in respect of complaints upheld by the trust and by the Healthcare Commission that were passed to the trust to be put right.

The actions that have now been taken and will be taken will turn Stafford hospital into a very good NHS hospital. With all the attention focused on it now, we are entitled to expect that, but beyond the immediate improvements we must face up to the challenges of sustaining the improvements, embedding the management, the culture, the clinical effectiveness and the public accountability, so that they will still be in place when the nation's interest moves on from Stafford.

I want to suggest three key requirements to ensure that our local hospital reaches the standard of the best and stays there. The first requirement is leadership, management and governance. We need a new leadership team, a new chief executive and a new chair of the trust. We need a completely restructured board of directors, and the full involvement of the foundation trust mass membership and its board of governors, the majority of whom are elected. When the boards of directors and of governors meet, they must meet in public, and the present interim chairman has given that assurance. We will seek the same assurance from whoever is appointed to the new leadership team. I was surprised to learn from a Library briefing that a foundation trust may decide to hold all its meetings in private, and that no one can stop that. Has the law not gone too far, and should it not be changed on that specific point? Whatever other hospitals do, I want my hospital to publish information on deaths, complaints and care standards. In the words of the commission's report, I want an open and learning culture.

My second requirement is clinical excellence—the Darzi agenda writ large. We must have proper training, supervision and accountability of staff. Staff should feel free to speak out about bad practice and near misses. Clearly, the hospital cannot learn from such incidents unless they are known about. I want management that means it when they say that their staff are their greatest asset. I want staff to be involved in decision making, and to have the confidence to speak up knowing that they will be listened to.

On targets, I have received briefings for this debate calling for more flexibility. The British Medical Association says that

"targets ought to be flexible".

The Royal College of Nursing says:

"The RCN is calling for a more realistic target of 95 per cent. of patients to be seen within 4 hours rather than the current 98 per cent."

I am definitely in favour of flexibility but, equally, if we get the quality of service right in A and E, meeting a target of a four-hour maximum wait should follow in most cases.

The third requirement is public and patient involvement. It cannot have helped the hospital that when there should have been good quality public and patient involvement the system for delivering that has been reorganised three times. We had a community health council, but it was abolished. A public and patient involvement forum was set up. It worked and it did things, but it was abolished. Now we have a LINk—a local involvement network. It has taken ages to set it up, but I am not sure what it has done to justify its name. The hospital cannot afford such drift. Like the trust management, we must now create a modern, effective body with real power, not just a talking shop. It must be a Rottweiler on behalf of patients and the public.

Photo of Rob Flello Rob Flello Labour, Stoke-on-Trent South

I applaud my hon. Friend for securing this crucial debate and for the hard work that he has done for his constituents. Given that he received assurances from the previous hospital management that everything was fine, what are his proposals to ensure that when statements are made at public meetings and information is provided, it is underpinned by good accountability?

Photo of David Kidney David Kidney Labour, Stafford

I said that in the case of my hospital, I want details of deaths, complaints and standards of care to be published. That is the sort of accountability that we want. We also want a management that allows staff to speak out and does not dictate that they must keep quiet, and we want public and patient involvement from a group of people who get things done and link back to the public at large. Just as the nation's interest will move on, so local interest will move on when people believe that their hospital is like every other hospital. I want people who remain dedicated and like Rottweilers on the hospital's case. Those are my three suggestions for securing a sustainable future for a good hospital.

I want to finish by returning to the argument for a pubic inquiry. When I applied to the House for an urgent debate nine days ago, I gave four reasons for a public inquiry being justified. The first was to find out how the trust managed to pull the wool over the eyes—if that is what it did—of the regulator and others for so long without being caught out. Does the system rely on too much self-assessment? Are there things that the new regulator should know about the tricks and loopholes that people can get through if we are not careful?

The second reason for a public inquiry is that I want there to be proper rigour, supervision and authority about the independent reviews of patients' case notes. An inquiry would be the right place to house the work that is being done on each of those cases. The third reason is the clinical failings at the hospital. What more, besides the understaffing that we know about and the lack of training that the report refers to, caused the hospital to fail so many times to deliver what the report regards as basic standards of care. The fourth reason is to find out what was wrong with the public and patient involvement. Was it just that the hospital did not do the sort of things that were done elsewhere, or is the system missing something that should be put in place? Those are the four reasons that I gave. I am not the only one saying that there should be an inquiry. Locally, the group that represents patients, Cure the NHS, says so. Nationally, the group that represents patients, the Patients Association, says so.

I received a briefing for this debate from the charity, Action for Victims of Medical Accidents, which says that there are still unanswered questions. It lists eight questions, and it is worth considering all of them. First, why did the Healthcare Commission fail to become aware of the problems at Stafford and delay intervening for so long? Secondly, why were the primary care trust and strategic health authority not aware of, or why did they fail to address the problems at Stafford? Thirdly, how did Monitor fail to recognise the problems at Stafford, and allow it to be given foundation trust status? Why did the different bodies fail to communicate with each other? Fourthly, why were the concerns and complaints of patients and relatives not properly addressed over a long period, and why did they not spark urgent action from any relevant body? Fifthly, what are the reasons for believing that existing and emerging systems of monitoring and regulating quality and safety, including the new Care Quality Commission, will prevent the same things from happening again? Sixthly, what measures have been taken to address the failings of individual board members, managers and other staff responsible? Seventhly, are the measures taken to identify which patients may have been harmed or died unnecessarily due to failings at Stafford adequate? Eighthly, what lessons can be learned at every level to prevent this from happening again? That is a powerful set of questions. Will the Minister and the Secretary of State not reconsider the case for an inquiry?

Stafford hospital is our hospital—the hospital that my family and I, like hundreds of thousands of other residents of the Stafford constituency and surrounding constituencies in Staffordshire, go to for care and treatment. We are horrified by the report's contents, confused that so many NHS organisations were involved but none made a difference, angry that the assurances given to us—given to me—by professionals over the past few years were completely misleading, and heartbroken for those who suffered when they should have been comforted and for those who died when they should have lived. We look to the Minister—I look to the Minister—to stand by us while we rebuild public trust and confidence in our Stafford hospital.

Photo of Bill Cash Bill Cash Conservative, Stone 3:01 pm, 1st April 2009

My constituents, too, are served by Stafford hospital and are devastated by what has happened and what has gone wrong, as am I. I place on the record my tribute to Julie Bailey and Debbie Hazeldine, who are here today on behalf of the patients' campaign group, Cure the NHS, to the Patients Association and to Ken Lownds for their sterling work on behalf of the patients and victims of this terrible tragedy.

The Healthcare Commission report has fulfilled a useful preliminary purpose. Its investigation would undoubtedly shorten and reduce the cost of an independent inquiry under the Inquiries Act 2005, which is the subject of an early-day motion tabled by the shadow Secretary of State—my hon. Friend Mr. Lansley, who is present—and signed by about 150 Members of Parliament. The investigation has achieved a considerable objective, but I refer to an independent inquiry because it would be independent by virtue of statute.

There will be various reviews, such as the review of case notes and the Alberti review, which deals primarily with accident and emergency. The review by the Care Quality Commission, which the Prime Minister mentioned, raises questions about conflict of interest, in that its inquiry will include an analysis of the role of the strategic health authority, in which the person now in charge of the Care Quality Commission was involved.

There is also the primary care trust review. However, those reviews and any internal inquiries will not be independent in any real and effective sense, despite claims to the contrary—I expect some from the Minister today—because they will not take evidence on oath or compel witnesses, and there will not be compulsory production of papers or protection of evidence given by whistleblowers.

The catalogue compiled by the Healthcare Commission is incomplete, because many people have come forward since that report was produced, including patients and victims, but surprisingly still no whistleblowers. The latest information that I have from the campaigners is that, since the report was produced, potential evidence has emerged of two fatal errors in accident and emergency; there are still shortages of nurses; there is a lack of understanding of an early warning system for patient deterioration; and a range of other matters are still going wrong. The Royal College of Nursing has already written to us with regard to a number of those matters.

No doubt the new interim chairman and chief executive will continue their work, but I stress that the Healthcare Commission report is only preliminary, and to put things right and deal with the cultural problem, which clearly has existed for a very long time and, some argue, goes back earlier than the period covered by the Healthcare Commission investigation, we need to know why this tragedy occurred. All those are reasons for an independent inquiry of the type that I have called for, which is supported by many Members of Parliament and by every newspaper in the Stafford area and indeed throughout the country.

Such a public inquiry was granted in 1984. I called for an inquiry as soon as I heard of the problems and deaths from legionnaires' disease at the very same Stafford hospital when I was Member of Parliament for the Stafford constituency. The Prime Minister of the day granted an inquiry as soon as I called for one.

The scale of the problem outlined by the Healthcare Commission and the depth of the problems of governance and management in the history of this situation are reasons for an independent inquiry, which would sort out what happened and why. That would enable substantial lessons to be learned both nationally and locally, and the Healthcare Commission itself acknowledges in its report the need to draw national lessons from what has happened.

There are many fundamental reasons why an independent inquiry is essential, and the Minister, in replying to the debate on behalf of the Secretary of State and the Prime Minister, should reflect carefully on the fact that if he refuses to hold such an inquiry, that will be a reflection on his judgment and integrity. For the reasons that I am about to explain, in addition to what I have already said as a matter of principle, I believe that failure to hold an inquiry would amount to a cover-up, and furthermore that only a public inquiry would satisfy the points that I am about to make.

Those reviews are not independent in the sense in which I have explained independence. They are scattergun reviews, with different terms of reference and timelines for reporting, and they do not allow the compulsion of witnesses and papers. That is a vital ingredient to get to the bottom of this tragedy. If the Government refuse to have an independent inquiry under the 2005 Act, that will be a local and national disgrace.

Failure to hold a public inquiry would suit the trust, the strategic health authority, the Care Quality Commission, the board, the Secretary of State and the Prime Minister, but it certainly would not suit the patients or victims and it would not be right for the future of the hospital. A public inquiry would not only be independent and get to the bottom of what went wrong at the hospital, but it is needed for the following reasons.

The Healthcare Commission itself agreed that Mid Staffordshire NHS Trust had "fully met" all existing national targets between 2006 and 2008. The obsession with targets was one reason for the failure of the trust board. Furthermore, in 2006-2007, the trust met its targets despite disturbingly abnormal mortality rates. The Healthcare Commission report dated those as far back as 2003-04, and the Commission for Health Improvement criticised the quality of care as early as 2002. Therefore, the Healthcare Commission report of itself does not go back far enough. That is a reason for having an inquiry into what happened.

Dr. Foster Intelligence, which monitors mortality rates, put the trust as the eighth worst acute trust in 2008 and the second worst in 2007. The strategic health authority—whose chairman during much of that time is the new chief executive of the Care Quality Commission, established today—received mortality reports in 2007 and 2008. I called for an independent inquiry and raised my grave concern when I said to the Prime Minster and the Secretary of State that I believed that there was a conflict of interest—I said that on the Floor of the House; it is in Hansard—because Cynthia Bower was chairman of the strategic health authority, but is now chief executive of the Care Quality Commission.

On the "Today" programme this morning, Baroness Young of Old Scone—who has taken over the chairmanship of the Care Quality Commission, which the Prime Minister said on 18 March would take over the review of the Mid Staffordshire problem—said in reply to the question that Cynthia Bower appeared to have a conflict of interest that she had examined what Cynthia Bower did during the period in question and was satisfied. That is a travesty, given that in the minutes of a meeting of the strategic health authority board on Tuesday 18 March 2008, which I have with me, Cynthia Bower said that

"there appeared to be nothing to indicate anything out of the ordinary was taking place on mortality."

Baroness Young said that the tragedy at Mid Staffordshire had eluded everybody, whereas Mid Staffordshire had been ignoring what patients and victims were saying.

On the programme, there were also exchanges with the representative of the Patients Association in relation to the question of self-assessment. That is dealt with in the Healthcare Commission report, which came through a few days ago. It is shown that it was Government policy to revert to local assessment, rather than external assessment, in the legislation setting up the commission. The very fact that that has been so disastrous and the strategic health authority has not done its job properly shows that the Care Quality Commission will not be able to deal with those questions, which is yet another reason for an independent inquiry.

Indeed, I raised many of those matters with the Baroness a few days ago at a meeting in one of the dining rooms in the House of Commons. In the interview this morning, she said that what happened at the trust had eluded others and that she was satisfied with the outcome, but I do not see how that squares with what I have reported from the minutes.

Furthermore, there is the problem of self-assessment. The Care Quality Commission will not have the same function as the Healthcare Commission of reviewing complaints at a local level, and that is made clear from the report to which I have just referred. There is also much in the report about hearing the voices of patients, but the campaign group Cure the NHS has a catalogue of complaints that have not been resolved. Indeed, I am informed that there were no formal contacts between the hospital and the campaign group until it was far too late.

The Healthcare Commission end-of-term report emphasises that effective regulation combines listening carefully to users and staff and engaging with local patients' groups, and that is included in the new Care Quality Commission's statutory objectives. Even with the statutory objectives in the new legislation, can there possibly be confidence in the Care Quality Commission, given the tragic circumstances that have arisen at the trust and the failure of the SHA, which did not even visit the trust, not to mention the conflict of interest that I described?

Stafford borough health scrutiny committee was given information relating to mortality rates at its meeting with the trust on 13 August 2008, and I have that information with me. At the presentation, the trust claimed that those rates were "consistently below national average", but that seriously differs from other evidence, including that from the Healthcare Commission. The presentation also referred to independent reviews of mortality rates by the SHA and the university of Birmingham, none of which appear to have been accurate or substantiated. There were also extremely unreliable statements about the control of infections and MRSA—methicillin-resistant Staphylococcus aureus—and claims that there was a positive review by the Department of Health cleaner hospitals team. Finally, Monitor itself has clearly not performed its functions effectively in relation to the failings at the trust and the granting of trust status.

All in all, there has been a systemic failure internally and externally at every point on the compass by a wide variety of bodies charged with investigating and providing analysis, statutorily or otherwise. For the reasons that I have given, no confidence can be placed in the arrangements that the Secretary of State has put in place in relation to the trust, because they lack the fundamental elements of real independence, compulsion on oath and in relation to papers, and the protection of whistleblowers, which only an independent inquiry of the kind that I have called for can provide. On receiving notice of the Healthcare Commission report, which had been leaked, I went straight out to the public and called for an independent public inquiry, and I call on the Secretary of State to accept such an inquiry in the light of my submissions.

There is no answer to this question other than an independent inquiry—the people of my constituency insist on one, the people of neighbouring constituencies insist on one and every national, regional and local newspaper insists on one. I can think of no reason why the Secretary of State and the Minister should not agree to such an inquiry. If they do not, the Government's integrity will be at stake.


"I believe that failure to hold an inquiry would amount to a cover-up, and furthermore that only a public inquiry would satisfy the points that I am about to make."

I hope there will be a proper enquiry. They are STILL covering things up even now, and messing us around.

I am glad you have used the word "Gulag". It is a very apt word to use.

I am not well now.

Submitted by barbara richards

Photo of Tony Wright Tony Wright Labour, Cannock Chase 3:13 pm, 1st April 2009

I should not be here today—I should be at the funeral of a lady who died in Stafford hospital a few days ago. I phoned her husband last night to ask whether he would prefer me to go to the funeral or to come here, and he said that he would rather that I came here. I asked him about the care that his wife had received on ward 1 at the hospital, and the words he used were "absolutely brilliant". Indeed, he thought that it was so good that he and his family had been into the ward to thank the staff for looking after his wife, and he said that he intended to write to the chief executive to put on record the care that they had shown her.

I say all that partly because that lady's husband asked me do so, but also because much of what we say on this issue is necessarily extremely critical—how could it not be? It is worth inserting, therefore, the fact that there are clearly many people in the hospital who are doing their damnedest in difficult circumstances to provide good care to patients.

I have been through all my files again, looking at these dreadful cases, which go back more years than does the Healthcare Commission report. I would have read some of them out in the Chamber had there been more time, but I will mention just one, which relates to a former nurse on ward 10 last year. I do not have time to read out her experiences, although I would have liked to do so. However, she concludes:

"So many old people, lying dependent on too few staff was for me frightening. For them, many of whom were deaf, partially blind or crippled, they must have felt that they had been completely abandoned. I cannot believe that supposedly fully trained nurses, with vocation, care and compassion gain any satisfaction from such an abysmal situation".

The fact that that was written by a former nurse, who is describing her own experiences, is particularly telling.

We all knew from the cases that we were dealing with that something was going seriously wrong. When we finally got an inquiry because the figures had been picked up by Dr. Foster and then by the Healthcare Commission, and because of the persistence of the patients' group, I wrote to that inquiry in April 2008 to say that it should look at the pattern of complaints over the years

"as these have highlighted systematic care issues that I believe have needed attention".

I think we all felt that. The tragedy is that it finally took a Healthcare Commission report to bring to light things that we knew were happening.

Perhaps the worst thing is that each time we worked with families to pursue complaints, we got letters back telling us that those complaints were being attended to and that action plans were being put in place. Indeed, I have records of those letters with me. I found one letter particularly chilling because it was written by a sister who had investigated a particular case:

"I apologise for the distress caused to" the patient—

"and her family and that she found the staff uncaring. We continually try to update our staff's knowledge and awareness in customer care and all staff have attended Confidence in Caring study days which addresses issues such as customer care".

When I read and re-read that, I had to wonder what state we had arrived at. We are told that nurses have to be sent on customer care courses to learn that care for patients is part of the job that they are engaged in. The trust's responses were unsatisfactory and it is a tragedy that it finally required a Healthcare Commission report to prove that.

The commission's report is very good and it tells us what happened. Essentially, it tells us that something was wrong with the organisation's whole culture and that that prevented it from being turned around. However, it does not tell us why things happened or what we need to do to ensure that something like this never happens again. As has been said, there are still questions hanging in the air. I am genuinely puzzled as to why, if such a situation existed for so long in accident and emergency and in certain wards, people in the system who knew what was going on did not come forward to speak about it.

I speak as someone who introduced the first whistleblowing measure in the House. The whole point of that was to give people the protection that would enable them to go to the regulators and raise issues of safety or irregularity, yet it clearly did not happen in this case. The report from the Healthcare Commission says, in terms, that when it asked doctors whether they were happy for their relatives to be treated in the hospital, a majority said they were not. What were those doctors doing? Why did they not go to their professional body or the regulators? The note that we had from the British Medical Association is quite inadequate and simply says that what has emerged shows that there was a lack of consultants. Yes, there was, but my goodness, it shows more than that.

Photo of Bill Cash Bill Cash Conservative, Stone

Without going into details now, I shall shortly be revealing what happened when a whistleblower got in touch with me. Apparently, he has been suspended—partly, if not entirely, because he spoke to me. In addition, he has been called in for psychiatric assessment. That smacks of the creation of a culture of fear reminiscent of things that went on in the gulags and under fascist and communist regimes of the past. That is the kind of culture that we must stamp out.

Photo of Tony Wright Tony Wright Labour, Cannock Chase

I was almost following the hon. Gentleman until the end of his intervention. I cannot talk about gulags, communism and fascism, but there is something seriously wrong when people feel that they cannot safely raise issues. Every organisation, and certainly every trust and hospital, should have a whistleblowing procedure that staff know about and feel confident with, so that they have somewhere to go, with their employment protected, when they want to raise legitimate issues of the kind in question.

We are still asking questions about those issues. As has been said, we are still asking very basic questions about how a quite elaborate regulatory system, with many different actors within it, failed to get to grips with what was happening over such an extended period. How can it be that in the Healthcare Commission annual health check in 2006 and 2007 Mid Staffordshire was described as one of the foremost improved NHS trusts? That beggars belief.

That is the case for saying that we have not yet come to the end of the story. We know a lot about what happened, the culture of the organisation and what was wrong with it, but we do not yet know enough about how it happened in the way it did, why it was not picked up along the way and, most importantly now, how we can be sure that in Stafford and elsewhere it never happens again. That provides a case for a further inquiry, which the Patients Association summarised succinctly:

"How a Trust with such a poor standard of care, longstanding issues with its mortality rates and consistently high complaint levels was able to progress successfully is a question that requires a full and frank answer".

We do not yet have an answer to that: how could a trust go through the regulatory system in the way that it did over the years and then receive a damning report of the kind that has now been produced?

There are many reasons for thinking about holding inquiries. Four or five years ago, the Committee of the House that I chair did a detailed inquiry on the whole business of inquiries, and we discovered that there are many reasons for holding them. Indeed, we asked the Government to try to work through a checklist of questions when deciding whether to hold an inquiry.

One reason for holding an inquiry is to provide public reassurance. Whatever else we say about the case, there is an urgent need for that. When the question of a further inquiry beyond those already announced by the Government was raised, I was genuinely unsure whether it would contribute to our knowledge of what happened. I wrote to Sir Ian Kennedy, largely because I respect him. He gave evidence to our inquiry about inquiries, many years ago, and I have known him over the years. He presided over the Bristol heart baby inquiry and has latterly chaired the Healthcare Commission.

I have today received Sir Ian's reply, which I am sure he will not mind my quoting:

"I cannot see that a further, large-scale and expensive exercise would add much."

He goes on:

"There are, however, other purposes having to do with catharsis and healing (which I found to be very important in Bristol). I cannot see that these need to be achieved through a public inquiry, but I do think that they should not be neglected."

He goes on to describe mechanisms that might do the job.

I do not think that we should get hooked up on this point. We need answers to questions that still hang in the air, but how best to get them, and how to provide public reassurance that the issue has properly been explored and that we have learned the lessons, is something about which we can have an intelligent discussion.

I support an inquiry because the people I represent believe that they need one—that is the public reassurance and catharsis point. The fact that they feel they need an inquiry is a reason why they are entitled to expect us to support it. One reason for my originally being somewhat hesitant about the inquiry issue was that I did not want an inquiry to go on for ever, make a lot of money for lawyers and not tell us much more than we know now, when what people are entitled to expect is a relentless focus on ensuring that the hospital in question moves from being one of the worst performers in the country to being one of the best. Whatever else we may say about what has happened, that is an obligation on us all.

Photo of Anne Begg Anne Begg Labour, Aberdeen South

I should inform the Chamber that I shall call the first Front-Bench spokesman at 3.30.

Photo of Evan Harris Evan Harris Shadow Science Minister 3:26 pm, 1st April 2009

With that warning ringing in my ear, Miss Begg, I rise to pay tribute to Mr. Kidney for the way in which he has handled himself throughout this whole sad business and for the way in which he introduced the debate. I agree with everything that Mr. Cash said—a rare occasion—and almost all of what Dr. Wright said. I declare an interest in a couple of respects: I am a member of the British Medical Association and on its medical ethics committee, and a vice-president of the Patients Association. My father—this is relevant, as you will hear in a moment, Miss Begg—was professor of child health at Alder Hey before the regime of Professor van Velzen, and in fact appointed him.

I have come to the debate today—I am pleased that the Opposition parties have sent their shadow Secretaries of State to respond, to show how seriously they take it—because I feel both angry and guilty about how, when I was a Front-Bench spokesman, I failed, I guess, to get the point across strongly enough about one aspect of the causes of what happened: the role of targets. I do not claim that that was the only cause, because it was not, but it was clearly contributory.

On page 49 of the Healthcare Commission report, which I shall not read out, there are clear examples of how the operation of targets had an impact on patient care. I do not claim that it is only targets that are the problem; clearly, the way in which the management handled them contributed too. However, there was a fundamental problem with them. I remember a conversation with the hon. Member for Cannock Chase about targets when his Committee was conducting an inquiry, and I thought that its recommendations and conclusions did not quite match some of the fundamental problems.

I am concerned because in a Westminster Hall debate on A and E on 10 September 2003, in a speech devoted entirely to the impact that targets could have on distorting clinical priorities, I said at column 85WH that I had been complaining for six years about the imposition of targets, which worked against the best interest of patients and the health service. I pointed out that the four-hour target for processing people through the department was the wrong measure. On 3 June 2003, as an example, I cited to the then Minister, who is now the Minister of State, Department for Innovation, Universities and Skills, Mr. Lammy, a BMA survey showing that

"a majority of respondents in A and E felt that the measures taken"— in relation to targets—

"'had distorted clinical priorities . . . and many said that waiting times for patients with the most serious conditions had increased'" and that

"'patients were being rushed through A & E, inappropriately admitted, or transferred to the wrong department.'" —[Hansard, 3 June 2003; Vol. 406, c. 2.]

It is all here the report. The failure of inspection—the failure of oversight—is a serious matter. There were more deaths in Stafford than in Bristol; there was heartache at Bristol, but no deaths as a result of such shockingly poor practices. Given that there was a public inquiry into what happened in Bristol, there must be a case for holding a public inquiry into what happened at Stafford hospital.

My question to the Minister is this: will one of the inquiries, perhaps that of Professor Alberti, look at the role of targets, the fact that the Government insisted that they had to be met and the way in which they were implemented at Stafford hospital? I believe that the inspectors were unaware that the trust was failing, as it was meeting targets. That reassured everyone. If the Minister were to answer that question, I should be grateful.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health, Liberal Democrat Spokesperson (Health) 3:30 pm, 1st April 2009

I, too, congratulate Mr. Kidney on securing the debate. As others have done, I pay tribute to the way in which he has conducted himself and the way in which he has put his case. I agree with everything that he said.

The scandalous litany of failure, which has been going on for so many years, demands an independent public inquiry. Mr. Cash and I called for an inquiry in response to the statement made a couple of weeks ago, and I maintain that view. It is always easy in such cases to find a scapegoat, blame the chief executive, and then move on. It is right that he should be held to account, but it is essential—it is the duty of the Government—to ask whether wider questions need to be asked about the causes of such scandalous failures. I therefore have some key questions for the Minister; he can answer them either today or in writing, but they should be considered also by a public inquiry.

First, as Dr. Wright said, what about the role of the clinicians? They were clearly understaffed and under a lot of pressure, but each of them had a duty to their patients. Did any of them speak out at any stage? What happened about the clinicians who were responsible for care in those hospital units? Has action been taken in respect of any of them, or have we quietly moved on? As the hon. Gentleman said, the comments of the British Medical Association are not adequate to address the concerns that have been raised.

Secondly, what about justice for the families who were so badly affected? What consideration has been given, and needs to be given, to how justice can be secured for them? Thirdly, what about the role of the coroner? It is utterly scandalous that the coroner should have obstructed the inquiry. What lessons are to be learned? What will be done to ensure that it never happens again?

My fourth question is about the role of the primary care trust and the strategic health authority. I have a copy of a letter that Sir Ian Kennedy wrote to the Chairman of the Health Select Committee, which I received only yesterday. Sir Ian raises some important questions. First, he says:

"The responsibility for managing performance, including effecting necessary improvements, lay and lies with the trust and its performance manager, the Strategic Health Authority, the commissioning PCT and, after the award of Foundation Trust status, Monitor. These performance managers are able to visit any trust and call for whatever information that they believe is necessary from the Trust to carry out their duties."

What did they do? What visits did they undertake, or was it simply a paper exercise, considering the death rates from afar? That is a central question.

Sir Ian also says:

"Following normal practice, efforts were made"— by the Healthcare Commission, as part of its investigation—

"to liaise with the trust and the SHA to explore what was needed."

What co-operation did it receive? Was the response adequate, particularly that of the strategic health authority? Sir Ian then says:

"The investigation team at the Commission did not know that the Trust was being considered for this status"— that is, foundation status; I find that utterly extraordinary—

"and was not asked whether there were concerns about the performance of the Trust in terms of the safety and quality of care...We understand that Monitor asked the Strategic Health Authority for its views; the SHA was aware of our work on mortality outliers and 'alerts' by then."

That is scandalous. Why did the strategic health authority remain silent? The allegation is that it was sleeping on the job. That leads us to the chief executive of the SHA, who today takes over the national Care Quality Commission. She must be a player in a fuller investigation of the scandal. As the hon. Member for Stone said, there would be a conflict of interest if the matter was considered in-house rather than independently. That is why independence is so important. Another factor is that her predecessor as chief executive of the then strategic health authority is now chief executive of the NHS.

Photo of Bill Cash Bill Cash Conservative, Stone

Does the hon. Gentleman not agree that it is so serious that it is impossible to imagine the evidence of the strategic health authority being evaluated in this context in such circumstances? It will be impossible, with such a conflict of interests, to get things right without a public inquiry of the kind that we have called for.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health, Liberal Democrat Spokesperson (Health)

I agree.

The fifth critical question, as my hon. Friend Dr. Harris made clear, relates to the role of enforcement of targets—in this case, the four-hour target. Under the heading, "What were the reasons for the failings at the trust?", the Healthcare Commission report says:

"Doctors were moved from treating seriously ill patients to deal with those with more minor ailments, in order to avoid breaching the four-hour waiting time target. Patients were moved to the clinical decision unit to 'stop the clock' but were then not properly monitored, since this area was not staffed."

It beggars belief that the Secretary of State did not mention the four-hour target in his statement, and the bullying culture that pervades the enforcement of such targets.

Photo of David Kidney David Kidney Labour, Stafford

Will the hon. Gentleman give way?

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health, Liberal Democrat Spokesperson (Health)

I am sorry, but I do not have time.

Surely there is a duty on the Government to look beyond what happened in that hospital and consider other factors, such as the four-hour target. Wherever I go in the country, I am told by hospital clinicians that, yes, the four-hour target has been beneficial, but I am also told about the bullying culture that surrounds its enforcement. If the Government refuse to consider that, they are failing utterly in their duty. Page 49 of the report shows a graph of when patients leave A and E. Sure enough, there is an enormous spike on the four-hour point, which suggests that people are being shunted out of A and E because the four-hour target has been reached. The Government need to consider that most carefully.

My final question is how on earth can the hospital have possibly cleared all the hurdles to securing foundation trust status, given that the failures had been going on for so long? It had to pass the scrutiny of the primary care trust, the strategic health authority, the Department of Health, the Secretary of State and Monitor to secure it. It shows a tick-box mentality of the same sort that gave Haringey council three stars for its children's service just as the baby P scandal was unfolding. As other hon. Members have said, it has to be the subject of a full independent inquiry. It is scandalous, shocking and horrifying that those failures occurred in a national health service hospital. The NHS is an institution of which we are all proud, but this NHS hospital has badly let down patients in Staffordshire.

There must be a full independent inquiry. Lessons must be learned. Every time one of these awful incidents occurs—I remember the last one, when we were discussing Maidstone hospital—we always say that it must never happen again. Then another incident occurs in a hospital that has been found to have passed through the regulatory process. At some stage, this must come to an end. We must be able to have faith in our NHS hospitals. It is the Government's duty to ensure that an independent investigation takes place, to get to the full truth of what happened.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 3:39 pm, 1st April 2009

I join other Members in thanking Mr. Kidney on securing this debate and on the manner in which he introduced it. We all appreciate the contributions made by him, my hon. Friend Mr. Cash, Dr. Wright and others with personal knowledge of the patients treated at Stafford general hospital.

Time permits me to make only a small number of points, so I shall focus on the issues as seen by patients themselves. In the immediate aftermath of the Healthcare Commission's report, it became glaringly and painfully obvious that the people who knew what was happening had no power, and that those who had power either did not know what was happening, or did not care sufficiently. That situation must change. My hon. Friend and others called for an independent inquiry on the day of the Secretary of State's statement, but I must confess that I was reluctant to support it, as he will know, because the Healthcare Commission, for the purposes of its investigation, was an independent body aiming to establish what happened. It has reported and done so capably, but it is perfectly clear from the report that it did not consider it part of its job to question policy or to make recommendations relating to it.

One might say that it is our and Ministers' job to determine policy, but sometimes Ministers are in denial. As the hon. Members for North Norfolk (Norman Lamb) and for Oxford, West and Abingdon (Dr. Harris) said, the Healthcare Commission's report explained in detail how the target culture of downward pressure and tick-box target adherence contributed to the failures at Stafford general. Why then did a Minister, on the day that the report was published, say that it had nothing to do with targets? I think that Ministers are in denial about the conclusions set out clearly in the commission's report. They have commissioned further reviews. For instance, they have asked Professor Sir George Alberti to visit the hospital to examine compliance with the requirements for best practice and treatment in emergency care. However, he will not question the target culture, because, for years, he has been the national clinical director inside the Department of Health responsible for the implementation of the target culture. There is no independence in that sense.

If the further reviews initiated by the Government are not independent, we cannot expect them to arrive at answers that command confidence. Patients and relatives so much affected, distressed and hurt by what has happened demand—and we should accept their demand—that they be given the opportunity to be heard; to see all the facts presented in public; to see behind the conclusions and evidence set out in the commission's report; to find out what the policy and regulation structures were that led to this situation, and why it happened; to secure closure; and, more than that, to contribute to the increased confidence that this will not happen again, either at their hospital or at somebody else's. Last week, I visited Stafford and spoke with Julie Bailey and others from Cure the NHS. From that conversation, I feel strongly that their underlying objective relates not just to what happened to them and their families, but to ensuring that quality of care for patients is, and remains, the absolute focus of NHS staff. We must put in place a mechanism, through an independent inquiry, to ensure that nothing gets in the way of that.

The hon. Member for Cannock Chase rightly raised the point that, day by day, in Stafford general hospital, patients are treated well—excellently, in many cases. There is nothing paradoxical—certainly not to me and those who know the NHS well—in the proposition that some patients in the same hospital are treated well, but others not. One can literally go from one ward, where the standards of cleanliness, hygiene and care are very high, to another, where they are not. The Minister might say, "Well, that is all about leadership"—of course, it is—but at Stafford general hospital, precisely the opposite set of circumstances applied to those in some of the hospitals that have responded best to the downward pressure for improvements in emergency services. In the very best hospitals, including some that I have visited, the response to that pressure has been to re-engineer the whole of their emergency activities so as to maintain high-quality care, while delivering on the Government's targets. In others, however—unfortunately, Stafford general is one of them—there has been no effort to re-engineer those activities to deliver and sustain quality through the appointment of sufficiently well trained staff. They clearly did not see the need for that. The Healthcare Commission clearly identified the nature of the problems with Stafford general's emergency department and the subsequent emergency admissions to other wards.

If every hospital was to succeed in delivering high-quality care, there would be no need for a regulatory system. If every hospital was to perform to the best of its potential, there would be no need for performance management. If every hospital could have any number of patients referred to it, without constraint or control, and still deliver high-quality care, without scrutiny and accountability, there would be no need for NHS health care commissioners. But we need all those things. None of them can be relied on to happen automatically. A worryingly large number of bodies are involved in the commissioning process. That primary care trusts, acting as commissioners, appeared to be concerned only with cost and volume, and not with quality, is a condemnation of the level and nature of the commissioning being undertaken by PCTs. When general practitioners referring patients were asked by the PCT whether there was a problem, they said, "Yes, we have many concerns." Clearly, however, they had no influence, which tells us something important about the failures of the local commissioning process.

The hon. Member for North Norfolk is right that there is far more to this story than is in the Healthcare Commission's report, which is entirely condemnatory of the role of the West Midlands strategic health authority. It was responsible for performance management and was told regularly by the commission about its concerns and the lack of co-operation from the Mid Staffordshire NHS Trust, but the SHA did not act or intervene. When the opportunity arose, it did not tell Monitor about the concerns before foundation status was granted. That tells us that far greater examination is needed of the role and influence of SHAs in relation to NHS trusts and, in particular, in this case, the then chief executive, who is now the chief executive of the Care Quality Commission. That needs to be independently examined.

Last Thursday, I visited the Mid Staffordshire NHS Foundation Trust. Despite the improvements made and the substantial recruitment of additional staff, there remains, inside the trust, a lack of acceptance of the failings that occurred and of an understanding of what is required to secure the confidence of the public that it serves. We have all learned, in many circumstances, that to learn from what has gone wrong is the starting point of getting things right in the future. On the day of the report, the interim chief executive, on behalf of the trust, wrote to hon. Members and members of the NHS foundation trust. In that letter, he neither accepted the report in full, acknowledged in detail the scale and severity of the failings, nor explained how the hospital's underlying cultural problems, the responsibilities of front-line clinicians or engagement with patients and the public would be altered. The letter literally just said, "This is what we've done. Here are the additional staff we've recruited. In effect, it's time to move on." It is not good enough for the hospital to say that it is time to move on and that it will improve things in the future. We need to understand what happened, and Ministers must accept that we can only do that through an independent inquiry.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health 3:50 pm, 1st April 2009

I congratulate my hon. Friend Mr. Kidney on securing this debate and on giving hon. Members an opportunity to discuss in more detail the very serious findings of the recent Healthcare Commission report. I will endeavour to answer the questions that he and other hon. Members have raised in the short time that we have left. If that is not possible, I will write to him and to other hon. Members after the debate. The Secretary of State and I have made it clear that our doors are open to anyone who wants to raise issues with us over the forthcoming days and weeks.

I will not go over the details of this report again. It is well known to hon. Members, who have repeated many of its dreadful details today. Suffice it to say, it represents a catalogue of catastrophic management and governance failure at Stafford hospital. My hon. Friend is right in his analysis of the chronology before 2007. One of the reviews announced by the Secretary of State—I will talk about it in more detail in a moment—will look at exactly what happened before 2007.

What is clear from the Healthcare Commission report is that it was only when it developed a more sophisticated approach to analysing mortality rates in hospitals in 2007 that it was alerted to the possibility of a serious potential problem at Stafford. My hon. Friend asked for an assurance that the hospital is now safe. The Healthcare Commission itself has given a public assurance that emergency care at the hospital is now safe. As an extra assurance, we and Monitor have asked Sir George Alberti, our national clinical director for urgent and emergency care, to conduct a review of the trust's procedures for emergency admissions and treatment. He will also examine its progress against the recommendations made by the report.

My hon. Friend also asked whether Professor Alberti's review can be widened. It is understandable that the review should focus on the emergency care and related services that were the focus of the Healthcare Commission's report, but we have made it clear that there should be no no-go areas for his inquiry. He is free to go anywhere and ask any questions he likes. He would actively welcome input from hon. Members and members of the public. I can assure my hon. Friend that the findings of the report will be made public. Professor Alberti will be happy to discuss them with him, other hon. Members and members of the public.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I ask the hon. Gentleman for his forgiveness, but I have seven minutes left to answer many questions. I will get to the questions that he raised, and I do not intend to give way.

The second piece of work that has been launched by the Secretary of State is investigating what went on before the Healthcare Commission's investigation and why alarm bells were not ringing earlier. It will look specifically at the roles of the primary care trust and the regional strategic health authority. It will be conducted by Dr. David Colin-Thomé, the national clinical director for primary care, and, again, it will have no no-go areas.

I come now to the third piece of work. Hon. Members asked for an assurance that no other accident and emergency departments in the country were running their operations in the same disastrous way as Stafford. The Healthcare Commission has already said that it has rechecked all of those hospitals with what are called outlier hospitalised standard mortality rates, and is satisfied that they do not give cause for concern. NHS chief executive David Nicholson has also written to all NHS organisations, drawing their attention to the Stafford report and requiring them to satisfy themselves that similar failures cannot occur within their own organisations.

The fourth piece of work, in response to the commission's report, is that the trust is offering an independent review of patients' records for anyone who would like it. My hon. Friend asked me how that work was progressing. I am informed by the new management of the hospital that they have established a helpline, that they have already had 40 inquiries and that they are setting up a group of independent clinical experts to look at and examine the records of anyone who wishes that to happen.

My hon. Friend asked what personnel changes were happening, had happened and would happen at the hospital. I think that he recognises that personnel decisions at a foundation trust are for the board of that trust and for Monitor. Most of the old board, including the chair, have gone without any severance payment. There is a new acting chair, chief executive and medical director.

The previous chief executive, Martin Yates, has been suspended, while an independent investigator examines his role. The new acting chair is also examining the overall past governance and management of the trust. We have made it clear that the new management must make decisions that mean that the hospital can command the confidence of the public and that wrongdoing is dealt with. Moreover, there should be no rewards for failure. Personnel decisions must be swift, within the law and follow due process. Summary dismissal may provide people with some initial satisfaction, but that is likely to be short-lived if it is successfully challenged in court or at industrial tribunal.

I agree with my hon. Friend that boards should be open and should meet in public. I understand from the new chair of the Stafford trust that the board will meet in public. Moreover, I point out to my hon. Friend that the code of governance for foundation trusts encourages directors to promote openness in decision making and in the processes at meetings.

A number of hon. Members have made substantive calls for a public inquiry. The Secretary of State promised to give the matter further consideration after receiving representations from my hon. Friend and patients' groups during his visit to Stafford hospital last week. He accepts that public inquiries can be an important mechanism to establish independently the cause of a problem or disaster. However, in this case, the Healthcare Commission, the independent regulator expressly established by Parliament to scrutinise and investigate the NHS, has conducted a full investigation and produced a detailed report laying bare the failures at Stafford hospital. My right hon. Friend believes that a public inquiry would add little more to our understanding, be time-consuming and, crucially, distract the new management and staff at the hospital from focusing on further improving the quality of care for local people.

In a letter to my hon. Friend Dr. Wright, Sir Ian Kennedy spells out why he does not think that a public inquiry would be helpful. It was Sir Ian, after all, who chaired the Bristol public inquiry. Sir Ian says that he would be happy for his letter to be circulated more widely. However, if my hon. Friend or anyone else believes that there are issues or lines of inquiry that have not been addressed by the Healthcare Commission report or the subsequent reviews, the Secretary of State would be only too happy to consider them.

I urge anyone who has outstanding concerns or criticisms to make those known to the Alberti and Colin-Thomé reviews and to the new regulator, the Care Quality Commission, which begins its work today. The Care Quality Commission said that it will re-investigate Stafford hospital before September to ensure that improvements have been made.

I fundamentally disagree with some of the points that were made by hon. Members on targets. To try to blame what happened in Stafford hospital on targets is to let the management and the board off the hook. Hospitals up and down the country ensure that people do not have to wait more than four hours in accident and emergency, which is a perfectly reasonable standard, while at the same time providing safe and high quality care. The vast majority of hospitals in England meet the accident and emergency waiting target, and there is a very strong correlation between hospitals that perform well on the A and E target and their overall quality of care.

The new consultant at the A and E department in the Mid-Staffordshire NHS Foundation Trust told the Secretary of State last week:

"When you get the quality right the targets look after themselves."

I could not have put it better myself.

Norman Lamb raised the issue of the coroner. Concerns have been raised in the report by a number of the families. My right hon. Friend has spoken to the Secretary of State for Justice about that, and officials in my Department have spoken directly with the coroner. He has made it clear that he is happy to facilitate the exchange of information with all of the ongoing reviews. He has also said that he would be happy to receive any application from a bereaved relative to have individual case notes examined.

I hope that I have managed to address most of the points. I know that I have not addressed them all, but I will write to hon. Members. I urge hon. Members to stay engaged with the new hospital leadership and the ongoing reviews that have been announced. I stress again that my door and that of the Secretary of State will be open to them over the coming days and weeks.