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5 Dec 2006 : Column 53WH—continued

She was told that her mother was suffering a massive infection that was causing her vital organs to cease working; her mother died within the hour. Her request for an inquest was refused.

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Another member of the action group wrote:

The same correspondent says:

She mentions her brother who developed an infection after an artery graft and ended up having his leg amputated.

There are two more letters that I should like to quote, which I think are significant for the debate. A man told us about his father, who died three weeks after being admitted to hospital. He was admitted to the ward, but had a fall. It was suspected that he had broken his hip. However, it took five days for the hospital to confirm that, and during that time he was doubly incontinent, and in severe pain. On numerous occasions the family would arrive on the ward to find that his food and drink had been left out of his reach.

Finally, a lady wrote:

It is true, of course, that some of those patients would have died anyway of the illness that led them to be in hospital in the first place. The concern that has been repeated to me over and over again is that, even if death was inevitable, basic standards of care, cleanliness and dignity should still have been provided, and in too many cases they were not. Ensuring that very basic standard of care is the responsibility of the hospital’s management. Quite a few of the people who have contacted me about this matter have urged me to press for resignations from the senior management and the chair of the trust. If senior management continues to resist the external inquiry that the public are demanding, I fear that there may be an increase in such requests in future.

I was disappointed when my request for an independent external inquiry into the problems was turned down. I felt, and still feel, that the hospital cannot be regarded as a learning organisation. There is a theme in the events that I have described. It seems that when things go wrong at Tameside hospital the reaction is to look elsewhere to attribute blame—MRSA is not hospital-acquired, but home-acquired; the high mortality rate is somehow the fault of Shipman; and the loss of public confidence in the hospital is the fault of the coroner. What is more, the
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team that has been set up by the hospital to look into the issues arising from the coroner’s comments is dominated by the very people who carried ultimate responsibility for the problems that were identified. That means that in effect they will be investigating themselves. I do not believe that, given the previous tendency to look for a scapegoat, we can expect an internal hospital inquiry to come up with recommendations to tackle the deep-rooted, systemic and cultural problems that mark out Tameside hospital, and which are the responsibility of the hospital management.

Significantly, the Tameside hospital action group shares that view, and is steadfast in its determination to press for the independent inquiry that is its core demand. From what I have been told, we can expect an imminent announcement from the hospital about its plans to address the issues arising from the coroner’s comments and from the many cases that have been brought to the fore by the action group. I hear that the hospital board has approved a 17, 19 or even 21-point plan, which, like the long forgotten plan of 18 months ago, will address a range of issues. I am sceptical. The action group will be sceptical. I agree with it that nothing other than an independent external inquiry will do, and nothing that the hospital management has thus far proposed persuades me to waver from that view. I hope that what I have said today will be sufficient to persuade my hon. Friend to think again and order an independent look at Tameside hospital. I look forward to my promised meeting with the Minister or one of his colleagues, and I hope that I shall be able to persuade him also to meet a small deputation from the Tameside hospital action group.

12.49 pm

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate my hon. Friend not only on securing the Adjournment debate but on bringing to our attention the horrendous experiences of some of his constituents. I recently launched, nationally, a dignity in care campaign, because we believe that too many older people are not treated with the dignity and respect to which they are entitled, in a variety of care settings—on hospital wards, in nursing and residential homes, and even in services provided through domiciliary and day care. We are not only launching that campaign but seeking to stimulate a debate in every community, neighbourhood and care setting about the care that older people should be entitled to expect in a civilised society. Indeed, we are not only stimulating a debate but seeking to stimulate action from those who are charged with fulfilling the relevant responsibilities, whether they are in management and leadership positions or professionals working on the front line.

I think that my hon. Friend would want me to say that many people in the hospital, in his constituency and elsewhere in the NHS do a fantastic job in difficult circumstances, and we would not want to question their sensitivity, compassion and skill in any circumstances. As my hon. Friend said, there is much that is good about the hospital and the trust, which have been objectively inspected and given a three-star
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rating. Beyond that, we know that much of what they do is good. However, that cannot be an excuse for the treatment to which the older people covered by the coroner’s comments were subjected.

We should test our reaction to this issue by asking ourselves how we would feel if our own family members were treated in this way. Would we regard that as acceptable and be prepared to tolerate it? The answer, I suspect, is that no Member of the House would expect somebody they loved to be treated in that way in any circumstances, but particularly when, as in the case of many of the older people we are discussing, they were coming to the end of their lives. In that respect, my hon. Friend makes an important point. There is no suggestion that lives could have been saved in many of these cases. There is, however, a serious suggestion that the very least that one can expect when families are under the most stress and experiencing the most insecurity and anxiety, and when the older person concerned is sometimes in a lot of pain, is the greatest sensitivity, compassion and care. The evidence before us suggests that that has sometimes not been the case.

I understand that the report that the trust has conducted is due to be published tomorrow, and my hon. Friend will receive a copy, as will the relatives of the older people referred to by the coroner and the local authority’s overview and scrutiny committee. The report will obviously identify the internal inquiry’s findings, as well, I hope, as a programme of action. The overview and scrutiny committee is undertaking a review of older people’s deaths at the hospital and will no doubt consider the inquiry’s outcome and the recommended course of action.

I am very conscious of the development of the Tameside hospital action group, of which my hon. Friend has been a great supporter and champion. Essentially, it is a group of relatives who have come together and who feel that they have common experiences of the hospital’s not treating their relatives with the respect and dignity due to them. The message that I would want to come very strongly from the debate is that the trust management and the hospital authorities have a duty and a responsibility to engage directly with the action group and with relatives who have had such experiences. I say that for two reasons. First, many of those relatives are, frankly, owed an unequivocal apology. Public services, and those who lead and manage them, should be prepared to say sorry when that is appropriate. Secondly, however, they should do more than just say sorry, because many of the relatives want assurances that other families and older people in my hon. Friend’s community will not experience what they have experienced.

David Heyes: I am pleased to hear my hon. Friend say that, and the strong message from the members of the action group is precisely what he says it is: they are looking not only for an apology but, beyond that, for an assurance that patients at the hospital will not be treated in the way in which they saw members of their families treated. For the vast majority, that would give full satisfaction.

Mr. Lewis: As I understand it, the hospital has indicated a willingness to engage some of the relatives in staff training and in a dialogue with staff who work on the front line in the hospital, and that is desirable
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and important. Equally, however, it is important to engage with relatives and to recognise that much of what they have experienced is unacceptable, rather than to hedge one’s bets by using language that simply recognises and acknowledges that things should have been done differently. People have a right to expect higher standards of care. It is also important to persuade people in my hon. Friend’s constituency through action, not words, that older people will be guaranteed the highest levels of care. Frequently, as my hon. Friend said, people have serious concerns not about clinical practice or the quality of the medical intervention but about the aftercare.

My hon. Friend specifically mentioned an independent inquiry. It would be premature to give a decision on that one way or the other at this stage, because we have to analyse the content of, and the recommendations from, the trust’s investigation, which I understand will be in the public domain tomorrow. At that stage, my hon. Friend will meet the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), and I hope that he will have the opportunity to talk to her with representatives of the action group; indeed, I am sure that she will accede to a request from him to bring members of the action group with him. There will be an opportunity to discuss the content of the report, the experiences of relatives and the wish for a more independent inquiry, if that is still the wish after the report has been published. My hon. Friend and the action group will have an opportunity to make representations on those issues to my ministerial colleague.

It is important that I mention one or two things that the trust has been doing to improve the situation. In July 2005, it introduced matron’s rounds, which are used to assess the quality of nursing care in all wards and clinical areas. They place particular emphasis on basic and essential care, nutrition and hydration, and communication and documentation. With the exception of the emergency and critical care areas, the trust has eradicated mixed-gender wards. It has also implemented the red-tray initiative, which is a system commended by Age Concern. Under the initiative,
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nursing staff are discreetly alerted when a patient requires assistance with feeding, without making it evident to other patients or visitors. The initiative was introduced in conjunction with new nutritional screening guidelines and protected meal times for patients.

On MRSA, which is a significant issue at the hospital, an action plan has been developed and is being fully implemented. A team under the chairmanship of the trust’s chief executive meets every fortnight, and progress against the action plan has been reported to the Department of Health’s MRSA improvement team every week since its visit. In addition, the trust is working with the team to develop a bespoke antibiotic prescribing policy, which should have a dramatic impact on reducing infection rates.

It is therefore important to acknowledge that the trust has been taking practical steps directly to address the real concerns that people have articulated. Although good intentions, action plans, strategies and a renewed focus are important, the difficulty, as hon. Members will be aware, is that it is the everyday experiences of patients and their families in the wards at the hospital that will determine whether the local community is reassured that lessons have genuinely been learned from the poor practice that has undermined dignity and respect for older people on too many occasions. That is where the judgments will be made. As my hon. Friend said, the community has been scarred by the damage done by Harold Shipman, particularly in relation to the treatment of older people, and we must remember that in any debate on these issues.

However, the proof of the pudding will be when older people and their families see that things are improving at the hospital and that their dignity and respect for them have been put at the heart of the care that they are offered. We expect no less. I again commend my hon. Friend for bringing this issue to the attention of the House and for championing those who are often voiceless in such situations—vulnerable older people and their family members. I promise that we will work closely with my hon. Friend to address these issues.

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Sub-post Offices (Northamptonshire)

1 pm

Mr. Philip Hollobone (Kettering) (Con): I thank Mr. Speaker for granting us permission to have this debate and the Minister with responsibility for post offices for attending. I welcome my hon. Friend the Member for Wellingborough (Mr. Bone), who I know would like to make a valuable contribution.

The main purpose of this debate and my main mission is to ensure that the Minister does not leave it without being made fully aware of the strength of local feeling in the Kettering constituency and in the rest of Northamptonshire about the future of the county’s sub-post offices. That feeling is shared not only in the county’s many villages, but in its large and small towns. Local opinion is strong on the issue. People value local sub-post offices and are distressed that many have been closed. Residents are anxious about the fact that more sub-post offices are likely to close in the future.

It is not an exaggeration to say that as a direct result of the Government’s policy on post offices every sub-post office in Northamptonshire faces the threat of closure within the next five years. That is the case because of two Government policies. The first is concerned with the doubts about the ongoing provision of a subsidy for rural post offices. The subsidy is scheduled to run out in 2008 and there is no provision for it to be extended beyond that date. The second policy is the Government’s decision to abolish the Post Office card account in 2010. There is, as yet, no firm proposal either to reverse that decision or to come up with an adequate replacement for POCA. Those two aspects of Government policy could spell extremely bad news for every sub-post office in Northamptonshire and every customer who uses one.

Residents in the Kettering constituency and in the rest of Northamptonshire hold their post offices dear. It would be remiss of me if I were not to pay tribute to the local sub-postmasters and sub-postmistresses who work extremely hard on behalf of local residents. I should like to mention one or two people who are particularly inspirational in that regard.

The first such person is Mr. Toby Clegg at the Barton Seagrave sub-post office, who has been extremely innovative in providing services for local customers. As other sub-post offices have been forced to close, he has gone out of his way to ensure that displaced customers are offered the best service possible. Mr. Quentin Bland at the Grafton Underwood sub-post office is likewise a pillar of the local community, and offers services to local residents that are way beyond those expected of him in his role as sub-postmaster.

Sylvia Winter and her husband David run the award-winning Creaton sub-post office, providing a range of community services. Its closure would be devastating for local residents, who are currently collecting signatures on a petition that I hope to be able to present on the Floor of the House in the not-too-distant future. It would be devastating news for the larger towns in the Kettering constituency, such as Desborough, Rothwell, Burton Latimer, Brixworth and Moulton, and for the small rural communities if sub-post offices were closed.

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Mr. Peter Bone (Wellingborough) (Con): The sub-postmasters mentioned by my hon. Friend have worked for years and years to build their business. One of the things that seems to have been overlooked in the debate is that they were relying on good will in respect of that business for their retirement pension and because of the change in Government policy, that has been swept away overnight.

Mr. Hollobone: As ever, my hon. Friend makes an extremely pertinent and telling point. It is worrying for local customers that their post office may close, but, in many respects, it is even more worrying for the postmasters and postmistresses involved. There have been bitter experiences locally over post office closures. There used to be eight sub-post offices in Kettering, the largest town in my constituency, but under the ludicrously titled, “Post office urban reinvention programme” their number has been cut to five. The Windmill avenue, King street and Neale avenue post offices were all closed.

The closure of the Neale avenue post office means that there is no sub-post office in the northern part of Kettering. People used to be able to walk to the Neale avenue post office or park conveniently outside it, but now customers have to go to the main post office in Kettering, where the queues are often extremely long and where it is often difficult to park. The situation is thoroughly inconvenient for all concerned. The counter staff do their best in the main post office, but they are simply unable to provide the level of service that the former, smaller sub-post office at Neale avenue was able to provide.

The Windmill avenue post office was in the Pipers Hill ward, in the middle of Kettering. The area has a lot of elderly residents, and they used that post office to collect their pension. It was closed under the reinvention programme, despite the fact that the shopkeeper next door made a formal offer to the Post Office to keep that post office open. His application was rejected. In the absence of any other community facilities, the heart of the local community was lost when that post office closed.

Local residents are worried that similar reinvention proposals could befall the remaining sub-post offices in the constituency. Given the strength of local feeling on the issue, I extend a warm invitation to the Minister to visit lovely Northamptonshire. He could meet Sylvia Winter at the Creaton post office, or he could come to Rothwell’s post office. He could talk to sub-postmasters, sub-postmistresses and local customers in order to listen to their concerns at first hand. I know that he is sincere in what he does and that he takes these issues seriously, but so do local residents. They would welcome the opportunity to put their concerns about the future of the post office network directly to him. I hope that he will sincerely consider that offer.

Local sub-post offices provide not only post office services, but the eyes and ears of a local community. We all know, as constituency Members of Parliament, that many people in our constituencies have contact with other local residents only when they bump into them at the local post office. The local post office can keep an eye out for local residents who are experiencing medical difficulties, who might become confused or who have other issues that can be spotted. The post
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office acts as an unofficial social service. That needs to be recognised by Her Majesty’s Government when they make up their mind about the future of the subsidy for the rural post office network. The same is true in respect of the remaining sub-post offices in urban centres.

In conclusion, I want to get across to the Minister the strength of local feeling about this issue. Thousands of local residents in Northamptonshire want the Government to understand their anxieties, and to come up with clear policy statements about the continuation of the subsidy for the post office network, and about either keeping POCA or coming up with a suitable replacement. Our local communities depend on small post offices, and far too many of our most vulnerable people are involved for the Government not to listen to local concerns on the issue.

I thank you, Mr. Atkinson, and Mr. Speaker for the opportunity to put residents’ concerns direct to the Minister.

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