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Alan Johnson: They would not, in the sense that the primary duty is to concentrate on patient care. That is the primary duty of all clinicians. [ Interruption. ] Well, look, the worst mistake that we could make in this House would be to besmirch the whole of the NHS with what happened at Stafford, which was an absolute exception. I hope that the right hon. and learned Gentleman accepts that, because that is what the Healthcare Commission says. Anyone who has seen any NHS worker anywhere in the country who looks at what happened would be appalled. The chief executive of the NHS has today written to every trust board, drawing their attention to what happened at Stafford and asking them urgently to review the situation to ensure that they are doing the things that the Healthcare Commission has recommended Mid Staffordshire trust must do, which includes ensuring that patient complaints reach the board.
Dr. Tony Wright (Cannock Chase) (Lab): This is a shocking and shaming report, as my right hon. Friend has said, but it is not a surprising one. My files are full of cases describing a lack of basic care at the trust. That is why I wrote to the Healthcare Commission asking it to look at the pattern of complaints and saying that I thought that they highlighted systemic care issues. Now we know from this extraordinary sentence in the report that
the board did not routinely discuss the quality of care.
We are talking about a trust that had sky-high mortality rates and sky-high levels of upheld complaints that did not even routinely discuss the quality of care at board level. That is beyond belief. The Government have now rightly put the quality of care at the top of the NHS agenda, but how can we be sure that that really happens everywhere in the country?
Alan Johnson: My hon. Friends constituency covers Stafford hospitalhe will shake his head if I am wrongand once again I pay tribute to the work that he has done. The National Quality Board, among other things, will ensure that quality is central to everything that happens in the NHSagain, that came from the Darzi review. The process will involve presidents of royal societies and, crucially, patient representatives, as well as the regulators. They will be focused completely on ensuring the introduction across the country of quality metrics, CQUINcommissioning for quality and innovationand all the other terminology that is important to clinicians, so that quality becomes the organising principle of the NHS. It is their job to ensure that that takes place everywhere across the country. With that drive and commitment by clinicians, who were paramount in shaping Darzis review, my hon. Friend can be assured that quality will indeed be the guiding principle and that, as I said earlier, there will be no hiding place for poor patient care.
Dr. Richard Taylor (Wyre Forest) (Ind): During the years of deficit, strict vacancy freezes were put in place in all trusts. Will the Secretary of State reassure us that the vacancy freezes in Mid Staffordshire were not followed by a permanent reduction in nursing posts?
I can reassure the hon. Gentleman that there are no vacancy freezes. The Healthcare Commission has said that the hospital was drastically understaffed, and had been so for years. He is absolutely right to say that it had to move from deficit to surplus; it is quite
right that extra money going into the NHS must be matched by trusts handling their finances properly, but that must never, ever be at the expense of patient care. It is obvious that this hospital was understaffed for many years, particularly in A and E.
Mr. Gordon Prentice (Pendle) (Lab): Doctors and nurses are in the first line of whistleblowers. I want to hear my friend say loud and clear that clinicians have a professional obligation to speak out loudly when things go wrong, and to take any concerns to their professional bodies. Why on earth did that not happen in this case?
Alan Johnson: My hon. Friend is absolutely right. It is one of the great mysteries of Stafford that, as far as we are aware, that did not happen. The Healthcare Commission has said that clinicians and staff gave up registering complaints at the hospital because they felt that they were wasting their time, but I cannot answer the question of why those complaints did not come up through a different route. My hon. Friend is right to raise it, but there is no answer to it in the Healthcare Commissions report. Perhaps one will emerge from the other reviews.
Mrs. Lait: I apologise to the Secretary of State for interrupting him earlier. I put it down to the fact that I was horrified by the tale that he was telling us. Will he tell us who was responsible for the appointment of the non-executive directors of the trust, who was responsible for the system of appointment for the non-executive directors, and what qualifications the non-executive directors had that gave them the skills to be non-executive directors?
Alan Johnson: It was the chair and chief executive of the trust, before it became a foundation trust, and now it is the governors of the trust who are responsible for appointing the board and for ensuring that the people whom they appoint as non-executive directors have the skills to do the job.
Clive Efford (Eltham) (Lab): Although I accept that the Government should always keep targets under review, does my right hon. Friend agree that it is utter nonsense to suggest that targets were at the heart of this problem, and that that is a reason for health professionals to neglect people who are in urgent clinical need? Does he think that replacing the word targets with the word outcomes would somehow alter the fact that we were measuring the performance in our NHS hospitals? Is it not right that we need to learn
My hon. Friend is absolutely right[Hon. Members: Page 49.] Members are saying, Page 49. I have read every page of the report that the Healthcare Commission has conducted and written. It says that targets cannot be used as an excuse for basic failures in management. Hospitals all over the country are getting waiting times downthe Conservatives had a target of 18 months in their patients charterand it would be bizarre and perverse to say that, because this one hospital, Stafford, has been so appallingly managed and so understaffed, we will now take away the assurance that patients across the country have that they will be seen
by a specialist within two weeks if they are suspected of having cancer, that they will wait no longer than 18 weeks for their operation, and that they will wait no longer than four hours in A and E. That would be ridiculous. It is a bizarre argument and I do not understand it. On the point about outcomes, I suggest that my hon. Friend read the leader in The Times on Monday, which made the same point as eloquently as he did.
Mr. Douglas Hogg (Sleaford and North Hykeham) (Con): Does the Secretary of State agree that there has clearly been gross incompetence by management and staff in this case? That raises the question of what happens in the public sector when gross incompetence occurs. Surely he will agree that it is important that disciplinary procedures should be commenced as rapidly as possible, that due process must be observed, and that those responsible should be disciplinedand, if necessary, sackedand paid the minimum that the law requires.
Alan Johnson: The right hon. and learned Gentleman is absolutely right, but, as he said, this must be done through due process. I would expect that due process to be speedy and to come to a conclusion quickly, and neither I nor anyone else in the House wants to see any rewards for failure.
Rob Marris (Wolverhampton, South-West) (Lab): The NHS overall does a great job. Stafford hospital is just a few miles from my constituency, and I am outraged at what has happened. The Secretary of State said in his statement today that the management were obsessed with achieving foundation trust status. There have been far too many reorganisations of the NHS, both under this Government and under previous Governments. We have too many non-executive directors who are accountants, we have trust boards that are unbalanced, and we have too many senior managers in the NHS who are incompetent and not being fired. Will my right hon. Friend assure me that he and his Department will abandon the distraction of foundation trust status, which Wolverhampton is about to go through, and that he will try to ensure a better balance on trust boards so that we have fewer
Alan Johnson: My hon. Friend has strong views about foundation hospitals, which I do not agree with. He was right, however, in his first comment. The NHS, which deals with 1 million people every 36 hours, does a terrific job up and down the country. He is falling into the trap of equating Stafford with everywhere else. There are 115 foundation trust hospitals that do a terrific job and whose standards are very high. They are part of the NHS, but it is quite right that they should have that extra freedom if they prove worthy of it. The important thing is that it should not only be financial competence that determines whether they are worthy of that status; it should also be their very important focus on patient care.
Dr. Evan Harris:
Seven years ago I warned the Secretary of States predecessors and the hon. Member for Woodspring (Dr. Fox) that these political targets would
result in clinical distortions. Does the right hon. Gentleman accept that this hospital was a three-star trust and a foundation hospital under his Governments target metrics? Surely he cannot simply blame the managers, when they were told that they would lose their jobs unless they met the Governments priorities. According to the managers, these were P45 targets, and the Secretary of State cannot simply blame them for what has happened.
Alan Johnson: What the hon. Gentleman says about targets is stuff and nonsense. There is a debate about this issue. The Royal College of Emergency Medicine and the Royal College of Nursing think that targets are right. They think that the tolerance levels involved should be 95 or 96 per cent., rather than 98 per cent, but to turn Stafford into a technical argument about three percentage points is perverse, and it is unworthy of the report that the Healthcare Commission has produced.
Mr. Drew: There you go: theres an admission! If the model is used properly, and if governors are empowered, it offers by far the best method of accountability, despite political differences. Is it not about time that we had faith in this model and empowered the governors, so that we can prevent the Staffords of this world from happening again?
Alan Johnson: I believe that my hon. Friend might have shared the view of my hon. Friend the Member for Wolverhampton, South-West (Rob Marris) at the time when we were having the debate about foundation trusts. However, he now speaks very eloquently from his experience of the trusts, and I think that he is absolutely right.
Miss Anne McIntosh (Vale of York) (Con): Will the Secretary of State take this opportunity to assure the House that there are no systemic failures in the NHS system, and that his Departments regulations are not taking every ounce of initiative and flexibility away from the health professionals? For instance, if a patient is not eating at meal times, families are not allowed to visit in order to feed the patient. Is not that nonsensical? Can we not reintroduce a degree of flexibility into the arrangements, and trust the health professionals to allow what is best for the patients in their care?
Alan Johnson: I think that the hon. Lady has a particular incident that she wishes to speak to me about, and I would be very pleased to talk to her about it. I can reassure her that there is no systemic failure in the NHS, on any model. Of course, we now judge this independently; we have independent statistics. We have the Dr. Foster statistics, which are used only in this country, Canada and the United States. They are not hard and fastthere is a debate in the British Medical Journal this morning about thembut they are a very good indicator of when there is a problem in a hospital. These things never occurred before. Anyone who reads the report of what was happening at Bristol royal infirmaryin a data-free zone and without resort to independent regulationwill see that we have moved on a great deal since those dark days.
That leave be given to bring in a Bill to make provision for minimum standards in respect of accommodation for young people leaving care; to impose a duty on local authorities to ensure that such standards are met; and for connected purposes.
This Government have made massive progress in bringing in legislation to protect children and they have given a special focus to identifying and supporting children who are at risk of harm. The Children and Young Persons Act 2008 includes radical measures to improve the experience of young people in care, to deliver high-quality corporate parenting, to listen and respond to young people, to bring stability and continuity into every aspect of child care and, perhaps most of all, to create an uncompromising culture of high aspirations.
The Bill supports the high aspirations of the Children and Young Persons Act 2008. When a young persons accommodation is changed from a placement in a regulated settingthat is, a childrens home or foster placementto one that the Act refers to as other arrangements that are not regulated under the Care Standards Act 2000, the Bill will ensure that statutory minimum standards are in place to determine whether such accommodation is suitable.
It has been suggested that this Bill is not necessary because the regulations and guidance relating to the Children (Leaving Care) Act 2000 already place a general duty on local authorities to ensure that they provide suitable accommodation to care leavers. Certainly, a number of local authorities have developed exemplary good practice in supporting care leavers, including minimum standards to determine suitability, which they apply locally. The current framework should ensure that all care leavers are being placed in suitable accommodation that adequately meets their needs. In fact, however, the evidence from care leavers themselves and their care workers shows that in far too many cases it is not working. If the guidance from 2001 is not yet working and vulnerable young people are being placed at risk, we must conclude that a step change is neededand it is needed now.
The National Care Advisory Service reports that 10 per cent. of care leavers feel unsafe and 44 per cent. worry about their safety. The Rainer Home Alone report gives case studies of the actual experience of young care leavers, so I shall cite some. For example, it states:
There are serious problems with drug use amongst the other tenants. Its hard for Dan as hes struggled with that in the past and is trying to move away from it.
The room was on the very top floor, up a few flights of steps. Its really difficult to manage every day with a young daughter and a buggy. There were no cooking facilities, no food allowed in the room.
There were large amounts of rubbish and discarded food, with flies everywhere.
He felt uncomfortable even using the bathroom to wash. An older resident made inappropriate sexual advances to him and he still received no support. Eventually he was moved after being found unconscious in his room.
There was frequent harassment and discrimination from other tenants. The worst example saw her burgled and her pets were killed
Shes 25 miles away from all of her support networks, including the leaving care team and her social worker. She doesnt know anyone in the local area so she feels very isolated;
He couldnt sustain the training placement that hed won because of where he moved to and the distance involved;
The local housing department wouldnt let Paul bid on a property until he reached 18 but he had to move out of his moving on flat before his 18th birthday. So he had to move into temporary accommodationa hostelwhile they sorted things out. This was a major backwards step for someone who was doing well at living independently. The hostel was also in a different town which jeopardised his employment.
Young people spoke of having to wait months or longer, in local bed and breakfast accommodation, before the promised flat became available. A number of young people raised concerns about whether accommodation arrangements for care leavers are always sufficient to keep them safe from harm. Young people reported that they are given flats that are unclean and situated in bad areas.
Many were keen to make the point that their accommodation was filthy and that they did not feel particularly safe or secure. Other young people expressed concern at what they described as being forced to share residence with adults and other young people who they said they would never have been allowed to mix with whilst in care.
More recently, the experiences described to the associate parliamentary group on looked-after children and care leavers confirm that far too many young people are still being moved from care into unsuitable accommodation.
Part of the problem seems to be that what constitutes suitable accommodation in relation to care leavers is not described in any detail. By comparison, the fitness of premises requirements for childrens homes under the Childrens Homes Regulations 2001, issued under the Care Standards Act 2000, give detailed specifications that accommodation must be the following: adequately lit, heated and ventilated; secure from unauthorised access; of sound construction and kept in good order; equipped with what is reasonably necessary and adapted as necessary in order to meet the needs arising from the disability of any disabled child.
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