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I will consider the occupancy rate throughout the country to see whether it is causing problems, but the top priority is always safety. One
minute the NHS is being criticised for not being productive enough, and the next it is being criticised for being over-productive. Obviously, there must be a balance, but it must never compromise patient safety. [Hon. Members: It has.] Opposition Members say, It has, as if what happened at Maidstone and Tunbridge Wells were typical of the rest of the countryit is not. And it is an indictment of, and an insult to, NHS staff throughout the country to suggest that it is.
The hon. Gentleman asked about gross misconduct. I believe that gross misconduct has taken place. He asked when I knew about the financial package. The answer is 11 October. When I knew about the situation and saw the report, I immediately sought advice about what I could legally do. It is easy to have a knee-jerk reaction, believing that there are residual powers, only to find that the NHS has been opened up to damages. The hon. Gentleman is a former employment rights lawyer and therefore knows that one has to ensure that one has the correct advice before taking action. I have ensured that that happens.
The hon. Gentleman mentioned writing to trusts. The NHS chief executive is not only writing to trusts but doing so with a copy of the report. The hon. Gentleman will have seen a copy, including the photographs. It is horror story, which needs to be brought to trusts attention, not simply through a bland letter from the NHS chief executive saying that there was a problem, but by showing photographs and examining the chronological order. The hon. Gentleman asked an important question about why action was not taken earlier. I shall discuss that with the chair and the chief executive of the Healthcare Commission tomorrow.
Mr. David Winnick (Walsall, North) (Lab): Blaming targets is an unacceptable argument for incompetence and worse, and I am glad that my right hon. Friend has rejected it. Will he confirm whether the police are making investigations to ascertain whether appropriate charges can be brought against those in senior management at the time?
Alan Johnson: My hon. Friend will appreciate that that is a matter for the police. The Health and Safety Executive passed on the issue to Kent police, who are looking into it. I do not think that anything I can say would help the situation at the moment.
Miss Ann Widdecombe (Maidstone and The Weald) (Con): May I draw the Secretary of States attention to the debate in the House on 23 January 2007? After listing a catalogue of neglect and disaster at Maidstone hospital, I said:
One of my constituents telephoned his brother to say that he was in Maidstone hospital with C. difficile, sitting in his own diarrhoea, and that he wished he was dead.
Can anyone believe that when that is the standard of nursing, it has nothing to do with the spread of infection?[ Official Report, 23 January 2007; Vol. 455, c.1321-2.]
May I draw the Secretary of States attention to something that I identified at the time, but that has not been mentioned in his responses so far? It is the crucial
role of ward sister. Ward sister, unlike management, matron or the director of nursing, is there all day. She used to fulfil the role of boss: Nurse, why is that drip empty?; Nurse, why is this man in his own diarrhoea? If she still fulfilled that role [Interruption.]
Mr. Speaker: Order. I hear the hon. Member for North Durham (Mr. Jones) saying from a sedentary position, It is a speech. We are considering a serious matter, which is why I have allowed an urgent question. Let the right hon. Lady speak, because I understand that she has lost constituents.
Does the Secretary of State accept that, if ward sister fulfilled her former role, many of the difficulties might have been avoided? Does he agree that there are three main reasons for her not fulfilling that role? First, short-staffing means that she is nursing when she should be bossing and supervising. Secondly, she has become too much a commissioner of bandages and blankets rather than active on the wards. Thirdly, she spends too much time filling in formswhether that is related to targets or anything else is not the point; she spends too much time on officialdom. Does the right hon. Gentleman accept that I was right to say 10 months ago that if we get the role of ward sister right we will make a huge impact on the situation?
Alan Johnson: I do agree with that. If the role of the ward sister or matron is got right, we will go a long way towards tackling the problems. The right hon. Lady made important points, and I have no argument with the amount of time that she took to make them. She should be congratulated on raising the issue in January. Of course, as she will accept, the Healthcare Commission was in the midst of its investigation then.
I also agree with the right hon. Lady that the standard of nursing had everything to do with the problem, as the Royal College of Nursing and others have pointed out. We made an announcement a couple of weeks ago. I do not say this with the benefit of hindsight in relation to what happened at Tunbridge Wells and Maidstone. The right hon. Lady made the point that the matron and ward sister should have direct control not only over the cleaning arrangements and the contracts agreed for the hospital, but over the making of a report, at least quarterly, to the NHS trust board. The views of the ward sister and matron could not be filtered through various layers of management because the report, on these and other specific issues, would go directly to the trust board. That was the gist of our announcement.
I am afraid that I do not entirely agree with another point made by the right hon. Lady, because I think it detracts from her point about the standard of nursing at the particular hospital and her graphic account of patients being told, Go in the bed. That is the term that was used. The right hon. Lady and others will surely accept that that is not the standard of nursing that we find in our hospitals across the country; it is absolutely exceptional.
The excuse cannot be given that the management of the trust did not receive the right support. The right hon. Lady spoke of a staff shortage, but there are now about 85,000 more nurses in our hospitals than there were 10 years ago, and 280,000 more care assistants and the like. As she will accept, there is no excuse for the dreadful things that happened in that hospital.
I accept that there are issues that we need to tackle in relation to ward sisters and matrons. We should give them more power and make them much more assertive, and remove any bureaucracy that they feel is a hindrance to their role. As I said in my statement, I am perfectly willing to shoulder that responsibility. My point is that nothing must detract from the failure that occurred in those three hospitals, and nothing must excuse the appalling standard of nursing that was in operation.
Mr. Jim Devine (Livingston) (Lab): I agree with my right hon. Friend that this is a scandal, and that we all have responsibilities. When I worked in the national health service a domestic came on duty at half-past 7 and worked until 2 oclock, and another came on duty at 4 and worked until 8. As the right hon. Member for Maidstone and The Weald (Miss Widdecombe) said, that domestic was directly accountable to the sister or the charge nurse. Sadly, as a result of the compulsory competitive tendering introduced by the Conservative party, whether contracts were in-house or went to the private sector the number of cleaning hours fell substantiallyby as much as two thirds in some cases. Surely it is time to bring those services back into the national health service, remove private contractors, and make such people directly accountable to ward sisters and charge nurses.
Alan Johnson: Unfortunately, I must take issue with my hon. Friend. There is no correlation between this problem and whether cleaning contracts were in-house or in the private sector. At Maidstone the contract was in-house.
The solution lies in what was said by the right hon. Member for Maidstone and The Weald (Miss Widdecombe). What is needed is the right degree of management on the front line which can be pushed through to senior management. That is why it is crucial for the matron to have a say in how the cleaning contract is organised. She might believe that in-house cleaning was insufficient and should be put out to tender, or it might be the other way around. It is not an ideological argument; it is a question of how the wards can be kept clean. It is about consultants and medics washing their hands, and about the prescription of antibiotics, which is crucial to the problem of clostridium difficile.
Greg Clark (Tunbridge Wells) (Con): The report makes clear that the physical condition of Kent and Sussex hospital has contributed to the problem of infection control. Ministers have announced that a new 100 per cent. single-bedded hospital is to open in Pembury, with financial close expected to take place in March next year. Will the Secretary of State assure my constituents that the costs of any extra investment in infection control, any compensation payments that may be made, and the change in leadership of the trust, will have no impact on that financial close?
If there is one thing that my constituents would never forgive, it is a failure to learn the lessons of this episode, causing what has been a nightmare over the last three years to become a continuing nightmare for the next 30 years.
Alan Johnson: I can give the hon. Gentleman that assurance and I know that he and his colleagues are coming to see me soon to talk about this issue. Given the age of the hospital and the buildings involved, it is more imperative that we go ahead with those new hospital facilities than it was before this report. Nothing that happens hereno change in the management or fines levied on the trustwill in any way damage or inhibit the need for that new hospital to be built for his constituency.
Mr. Michael Fallon (Sevenoaks) (Con): The chairman has now resigned, but is the Secretary of State aware that the chief executive was allowed to leave by mutual consent, that the then director of nursing has been re-employed by the trust as a PFI adviser and that all the other non-executive directors remain in place? Why is no one at the top of these trusts ever dismissed?
Alan Johnson: As I said, a strategic health authority review of the leadership is taking place and I have asked for a separate review to be carried out urgently of what happened with the chief executives package. That review will also take into account all the leaders, including the medical director and nursing director who were on the board, and the non-executives. The hon. Gentleman makes an important point. We decidedthere was agreement on both sides of the Housethat Whitehall should not be making appointments, and that that should be pushed down to local level, but if the Appointments Commission is responsible for appointments, somebody has to be responsible for the un-appointment, as it were. That is an important point; who takes the blame?
Dr. Richard Taylor (Wyre Forest) (Ind): I accept the Secretary of States assertion that there are more nurses employed in the NHS. Has anybody looked to see whether there is a correlation between nurse-patient ratios in the hospitals that have more C. diff than others?
Alan Johnson: I do not know whether such an assessment has been made, but I undertake to ensure that one is made. The Healthcare Commission pointed out that there were fewer nurses employed at the hospital in question than at hospitals of a similar size, and that the level of training on hospital-acquired infections was very patchy. Between 40 and 50 per cent. of nurses received training, so between 50 and 60 per cent. of nurses did not, which just added to the catalogue of failures.
Mr. Jamie Reed (Copeland) (Lab): The Secretary of State will be well aware that the different nursing regimes that apply in different hospitals have the most important effect on the outcomes that we are discussing today. How can we spread the best practice that is exhibited in hospitals such as mine, the West Cumberland hospital, throughout the country?
Alan Johnson: My hon. Friend is right; the good practice that is going on day in, day out is essential, which is why we gave the code of practice a statutory basis by including it in the Health Act 2006. That cannot be ignored and should be driving the way hospitals work day in, day out. We also need to make safety the absolute priority in the operating framework, all of which means that what happened in those three hospitals should not have happened. We hope to ensure that it does not happen again. Best practice is one of the most crucial ways that we can ensure that this is tackled.
Mr. David Lidington (Aylesbury) (Con): May I remind the Secretary of State that it was as long ago as 19 July 2005 that the then Health Minister told me in a written answer that learning and best practice arising out of the Stoke Mandeville investigation
will be shared across the national health service?[ Official Report, 19 July 2005; Vol. 436, c. 1666W.]
Alan Johnson: I do not think that anything has gone wrong with the promise, in the sense that the vast majority of NHS trusts and hospitals are placing the correct emphasis on this matter and understand completely that washing hands, with soap and water in the case of C. diff, is absolutely crucial. The bare below the elbow policy was a piece of best practice that operated at the Royal Marsden for years, and which we have now made best practice and standard procedure across the country.
On Stoke Mandeville, I forgot to mention that the Healthcare Commission set out four reasons for the high rates of C. diff: poor environment, poor practice, lack of isolation facilities and insufficient priority given to infection control. Next week, we will have a Healthcare Commission report on Stoke Mandeville one year on, and it is important to see how the hospital has tackled clostridium difficile. That report will be of benefit to MPs in the Maidstone and Tunbridge Wells area, whose main concern is to ensure that such infection is turned around there as well. We need to keep track; we must have not only Healthcare Commission reports, but regular updates on how its recommendations are being implemented.
John Hemming (Birmingham, Yardley) (LD): In my constituency, there is a sheltered scheme for everyone who has returned from hospital in the past year who has been infected with some infection that they did not have when they went into hospital. The fact is that central management through targets is not the way to beat infection in hospitals; it needs to be managed locally on the wards. Bed occupancy of over 70 per cent. is a problem, as is managing the cleaners. Health staff travelling in medical uniforms on the buses is also a problem in respect of infection. There are many good cleaners, but bad cleaners are followed by infection. Will the Secretary of State give ward sisters the power to sack a bad cleaner?
Alan Johnson: I agree with all the hon. Gentlemans points about the key issues in respect of cleanliness, but I would add one more: public information. The public need to be aware of what goes on in hospitals.
I have mentioned the powers given to the ward sister. Within the realms of proper employment practices and the proper way to treat staff, we want the front-line staffward sisters and matronsto have the power to determine how the wards are cleaned. That would include pointing out in their quarterly reports to the NHS board where there are failures, including among cleaners. However, merely a cursory reading of the Healthcare Commission report reveals that hand washing was patchy among not only cleaners but medics, including consultants, and nursing staff. The blame was spread among all participants, not only cleaners.
Mr. Julian Brazier (Canterbury) (Con): Eight years ago, the Government took the decision to put the cancer ward at the Kent and Canterbury hospital under the control of the Maidstone and Tunbridge Wells NHS Trust, even though a joint cancer centre had happily operated for years without such administrative nonsense, and patient outcomes were consistently better at Canterbury. In view of the considerable hospital trust changes that will take place, may I urge the Secretary of State to consider transferring responsibility for that cancer centre back to the East Kent Hospitals NHS Trust where it belongs, and where all staff at all levels would like it to be?
Alan Johnson: I accept that the hon. Gentleman is taking this opportunity to ask us to look again at that matter. The important point is for this to be driven locallyby the local clinicians and strategic health authorityto ensure that we reach the right decisions, rather than for me to hand down tablets of stone from Whitehall.
Hugh Robertson (Faversham and Mid-Kent) (Con): The accusation that targets played some part in all this was not dreamt up by the Opposition; it is clearly there in the Healthcare Commission report. Another factor it identifies is that management spent too much time dealing with hospital trust reconfiguration and too little on patient care. On behalf of all my constituents in the mid-Kent part of my constituency who use Maidstone hospital, I ask the Secretary of State to give an assurance today that there will be no further work on that reconfiguration and no services will be taken away from Maidstone hospital until this matter is brought under control and, preferably, the reconfiguration is abandoned altogether.
Alan Johnson: That is just a variation on the Opposition policy of a moratorium on reconfigurations. In respect of the reconfiguration of maternity services in Greater Manchester, all the clinicians and other health care professionals were telling me that they had been trying for 40 years to make the changes, which would save between 30 and 40 babies lives per year, and that that had been rejected by politicians defending bricks and mortar. That is a general point about moratoriums.
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