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NHS Chief Executives
4. Mr. David Kidney (Stafford) (Lab): How many chief executives of (a) all NHS trusts and (b) foundation trusts are suspended from work. [265614]
The Secretary of State for Health (Alan Johnson): At the current time, I am aware of one NHS trust chief executive and one NHS foundation trust chief executive who are suspended from work. Chief executives and other executive directors are employees of their trusts, and suspension is a matter for the trust, acting in accordance with individual employment contracts and general employment law.
Mr. Kidney: I am grateful to my right hon. Friend for his answer. In Stafford’s case, where a thorough and damning report is already available, why has the chief executive not already been sacked? If the answer to that is that there is still due process to go through, what assurance can my right hon. Friend give me that it will be brought to an end soon, so that we can stop paying taxpayers’ money—that is hospital budget money—for someone who is doing nothing?
Alan Johnson:
I am sure my hon. Friend will accept that there is no point in acting in haste and then finding there is a tribunal decision against the Government. We
have to have due process. I want everyone’s case to be considered properly. I am very pleased that the trust has called in Peter Garland, a former senior official and regional director in the health service, to help it with the investigation and to look not just at the chief executive, but at the responsibility of the whole board for the dreadful events that were catalogued in the Healthcare Commission report.
Mr. William Cash (Stone) (Con): Will the Secretary of State take account of the fact that I am repeating my call for an inquiry into this whole matter under the Inquiries Act 2005? Will he also make it clear that all those in that trust who are culpable, as set out in the Healthcare Commission report—that includes other senior management besides the chairman and the chief executive at the time—must be removed and not merely suspended on full pay?
Alan Johnson: As I just said, the investigation will involve everyone who has any position of authority within that trust—the whole board and all the executive directors. It will be a proper investigation and it will be fair, and the action taken will result from that inquiry, not from any knee-jerk reaction by me or anyone else.
Mr. Brian Jenkins (Tamworth) (Lab): Will my right hon. Friend assure us that there is no suspension culture in the national health service? Would he like to hazard a guess as to how long the longest-serving suspended employee in the NHS has been suspended for? If not, could he please send me a note on that?
Alan Johnson: I do not believe that there is a culture of suspension in the NHS. There are 1.3 million staff in the NHS, and I cannot give my hon. Friend an answer on how many people have been suspended or what the longest period of suspension is. However, I shall see whether somebody can answer his quiz question and then drop him a line.
Sir Patrick Cormack (South Staffordshire) (Con): As I was in Northern Ireland on parliamentary business when the Secretary of State made his statement last week, may I make it plain that my constituents are acutely concerned about this report? We want to restore the confidence and trust that this hospital used to enjoy—it was a good hospital and it did have a good reputation. Would not the quickest way to do that be to have an expeditious public inquiry, so that all the facts and the reasons can come out and we can then go forward under a new regime?
Alan Johnson:
I believe the phrase “expeditious public inquiry” is a contradiction in terms, but I accept what the hon. Gentleman said. Indeed, I was very moved by the contribution of the shadow Chief Whip, the right hon. Member for West Derbyshire (Mr. McLoughlin), at last week’s business questions—he pointed out that his mother had died in that hospital, having received excellent care. We have to ensure that the hon. Gentleman’s constituents and those of my hon. Friend the Member for Stafford (Mr. Kidney), and other people who use that hospital are reassured that what the Healthcare Commission has said, in terms, in its report—that there has been drastic improvement, not least because of a huge increase in staff; staffing was at the core of the
problems—is indeed the case. That is why I have asked Professor Alberti to make a very swift report and to report back to Parliament in five weeks’ time.
Norman Lamb (North Norfolk) (LD): Whenever the chief executive of a failing trust, such as the Mid Staffordshire NHS Foundation Trust, is suspended it raises questions about where responsibility really lies. Is not the Patients Association right to repeat the demand for an independent inquiry, looking particularly at the regulation and supervision of hospital care? Is that not particularly the case in the light of the letter in The Times today from Dr. Howard Baderman, a retired accident and emergency consultant who wrote two reports for the Department of Health? He talks of a “grave failure” by the Department to act on those reports in respect of other hospitals. Do we not owe it to NHS patients to ensure that all the lessons are learnt from this dreadful scandal?
Alan Johnson: We do need to learn all the lessons, but I point out to the hon. Gentleman that there was no independent regulator until we introduced one—the important word there is “independent”. The Healthcare Commission report is independent. The letter in The Times this morning is strongly disputed, not just by the strategic health authority, but by people in the Department of Health who worked with the person who wrote that letter. We put patient safety first—we put it at the forefront of everything. I believe that the Patients Association will be reassured, not just with the Healthcare Commission report but with the three other reviews that are going on, and with the clear demonstrable fact that there is a very clear focus on finding out what happened at Stafford and why it happened—there is still an awful mystery to much of that—and on ensuring that we put the problems right, so that local residents can be assured that they have a safe hospital.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): How can my right hon. Friend ensure that any sacked chief executives, including the one at Stafford, do not receive financial benefits from their failures through some sort of golden pay-off?
Alan Johnson: In 2007, we issued instructions through the NHS Chief Executive, reminding trusts that if they plan to give any financial reward, payment or golden goodbye to any departing chief executive or anyone else, it requires approval from the strategic health authority and the Treasury. As far as I know, no one in those two organisations would give anything other than the statutory entitlement to individuals, because the Government—and, I think, the Opposition—do not want to see any reward for failure, which has been so apparent in other sectors of the economy, creeping into the health service.
Mr. Andrew Lansley (South Cambridgeshire) (Con): On 15 October 2007, after the terrible events at Maidstone and Tunbridge Wells NHS Trust, the Secretary of State said that
“we should be spotting these issues much earlier and getting rid of incompetent chief executives or chairpersons who, fortunately, are in the minority, rather than waiting for a report such as this, by which time, frankly, most of the damage has been done.”—[ Official Report, 15 October 2007; Vol. 464, c. 571.]
The Secretary of State knew about the failings at Stafford in May 2008, so why did he not intervene then and there?
Alan Johnson: I ask the hon. Gentleman to look at the Healthcare Commission’s report carefully. The difference between what happened in Stafford and in Maidstone and Tunbridge Wells, and the fact that the Healthcare Commission took into account those words and what others said at the time, is that as soon as commission staff went into Stafford and saw the problems—in May 2008—they immediately called the chief executive to a meeting, put their concerns to him, and started to see the process of improvement. That is the job of the Healthcare Commission while it carries out its inquiry. The staff cannot say at that stage that they have come to any conclusions, and it would be unfair, one day into an inquiry, to reach conclusions and say that heads must roll and recommendations must be made. We made that specific point to the Healthcare Commission at the time of Maidstone and Tunbridge Wells, so in Stafford staff immediately introduced measures to put things right, rather than wait for the end of the process and the report to be published—as I said they should do in that quote.
Mr. Lansley: I put it to the Secretary of State that he should look at the appendix to the Healthcare Commission’s report and the letter of 23 May 2008 that was received by his Department. If he meant anything by saying that incompetent chief executives should be got rid of at the point at which one becomes aware of them, it should have been done then, but the Department failed to do it. The Secretary of State has to understand that there was a failure, not just within the trust, but within the agencies charged with commissioning, performance management and performance assessment, up to and including the Department itself.
The Secretary of State’s proposed reviews—he now has three—do not have the scope, the powers or the independence to investigate those failures fully and, therefore, to restore public confidence. Will he agree today to institute an independent inquiry in the terms in respect of which I have written to him today?
Alan Johnson: We discussed this last week and there was no mention of an independent inquiry by the Opposition. The hon. Gentleman refers me to the appendix: let me refer him to the powers that the House gave to the Healthcare Commission. The commission could have immediately put that hospital into special measures. Its decision—as an independent regulator—was not to do so. It would have been quite wrong of Ministers to rush immediately to dismiss or discipline a chief executive when we did not even have any evidence from the Healthcare Commission. It had not reached any conclusion because it had spent only one day in the hospital.
Imagine a giant quango, the independent NHS board, trying to tackle these problems. The whole basis of the Opposition’s policy is to try to remove politicians from these issues. That is quite wrong, and we are right to deal with these issues in the way that we have.
Mr. Ken Purchase (Wolverhampton, North-East) (Lab/Co-op):
Of course our thoughts and hearts are with those who have suffered because of the debacle at
Stafford, but campaigners have drawn attention to many difficulties at the hospital over a very long period of time. The problem is that the board is stacked with accountants and solicitors who are not elected or responsible and who take no notice of what is going on. That is why we have ended up with what can only be called a tragedy. Will my right hon. Friend accept that the structures and targets in place for hospitals, such as looking for trust status and so on, distract them from delivering the care that they ought to be offering people?
Alan Johnson: I do not think that any neutral assessment of the Healthcare Commission report would conclude that the answer to the problem at Stafford would be to get rid of foundation trust status. However, my hon. Friend is right that the manager and the board at Stafford were seeking foundation trust status. To achieve that, incidentally, they had to put the trust into a proper financial position and save £4 million. They decided to save £12 million, and that is why there was one consultant and not four in the accident and emergency department, and why the hospital had three rather than 12 matrons. It is also why in the emergency assessment unit there was one nurse for every 15 patients, whereas most hospitals of that size have one for every six. Given that 85 per cent. of foundation trusts were considered to be excellent in their provision of services, it would be quite wrong to smear them with what happened in a badly managed and under-staffed hospital.
Children (Complex Health Needs)
6. Ann Winterton (Congleton) (Con): What steps he is taking to improve the care provided for children with long-term complex health needs. [265616]
The Minister of State, Department of Health (Dawn Primarolo): The Government’s policy is to provide co-ordinated support as close to home as possible for children with complex health needs and their families. “Healthy Lives, Brighter Future: the strategy for children and young people's health”, which was published in February of this year, built on previous commitments.
Ann Winterton: While I welcome the child health strategy, what plans do the Government have to increase the number of health visitors to assist children with long-term, complex needs? I understand that the numbers of health visitors have been cut over the past four years, so when will they be back to 2005 levels? What plans does the Minister have to provide adequate respite care for parents and other children in the family?
Dawn Primarolo:
I know that the hon. Lady follows these considerations very closely, and I commend her for that. She will know that the Government have committed extra finance, to a total of some £340 million over this spending cycle, through both the Department for Children, Schools and Families and the Department of Health. We have also made clear the future priorities for both the operating framework and the present structure. First, we need to address the issues of palliative care and short breaks. Secondly, we need to look at the clinical pathways and put in place individual care plans. That addresses precisely the point that the hon. Lady made about health visitors, for instance, and the complex needs of these young people. Finally, we must address
the question of managing medicines in schools. Those three sets of priorities have been identified by parents, people in the voluntary sector and the young people themselves. [ Interruption. ] If the hon. Member for South Cambridgeshire (Mr. Lansley) would just stop talking from a sedentary position, I would be able to answer the question. The day that the Conservative party provides answers to anything will truly be a damascene conversion.
I return to the final point made by the hon. Member for Congleton (Ann Winterton) about health visitors. I can confirm that the work being taken forward by the Government in the spring of this year will concentrate on the valuable role that health visitors play in meeting the complex needs of these young people.
David Taylor (North-West Leicestershire) (Lab/Co-op): Does my right hon. Friend agree that, when we talk about improving the care provided for children with complex care needs, we should focus particularly on respite care and day care, for the parents as well as for the child? The press covers far too many cases of parents whose lives have come to tragic ends because of the enormous stress and strain associated with providing care, over a very long period indeed, for a child with the extensive disabilities that we often see. We need to focus on the parents as well, do we not?
Dawn Primarolo: I entirely agree with the points that my hon. Friend makes, which relate particularly to the work being done on end-of-life care, and specifically to the requirements on which primary care trusts have been asked to focus, with regard to short breaks, and palliative and end-of-life care, for very vulnerable young people and children.
John Bercow (Buckingham) (Con): One group of children and young people with complex health needs consists of those who require high-tech, expensive communication aids to express their hopes, needs, fears and interests. I welcome the proposed joint commissioning pathfinders, to which the Government have sensibly committed. Will the right hon. Lady confirm that they will be taken forward with all due haste, and that the Government will look at other aspects of joint commissioning, and models for the provision of alternative and augmentative communication for children who are desperately in need of it?
Dawn Primarolo: I commend the hon. Gentleman on his excellent report, the recommendations of which the Government accepted. I can confirm that we will act on the specific points relating to the individual, and the very important support and care that individuals may need. We will also look at his recommendations on wider issues to do with speech, language and communication, and so at the collaboration that needs to take place beyond the health service, particularly through local area agreements, to make sure that we deliver on the recommendations that he rightly made.
Mr. Stephen O'Brien (Eddisbury) (Con):
The Secretary of State pledged in his first speech as Health Secretary to meet the care needs of people with a learning disability, but in the light of today’s shocking findings by the ombudsman on the NHS’s failures in long-term care for young people with learning disabilities, when will the
Minister of State and the Secretary of State convert the words of January’s strategy—itself an admission of the failure of the Government’s 2001 “Valuing People” document—into the action that is so urgently needed if we are to avoid a repeat of the shocking discrimination and damage suffered by those with learning disabilities?
Dawn Primarolo: I absolutely agree with the hon. Gentleman; the report is shocking. The Government are determined to make progress by accepting recommendations previously made to us, by concentrating specifically on care plans, and by working with GPs on identifying issues, early intervention and providing the correct support. The Minister of State, my hon. Friend the Member for Corby (Phil Hope), has today clearly indicated our determination to make sure that the very highest standards are available to all those who access our health services.
Mental Health Services
7. Lyn Brown (West Ham) (Lab): What recent assessment he has made of the adequacy of levels of mental health care provision; and if he will make a statement. [265617]
The Minister of State, Department of Health (Phil Hope): The level of funding for mental health has never been higher. Since 2001, real-terms investment in adult mental health services has increased by 44 per cent., and the national health service spent £5.53 billion on adult mental health services in 2007. We have 64 per cent. more consultant psychiatrists, 71 per cent. more clinical psychologists and 21 per cent. more mental health nurses than we had in 1997, and are providing better care and support for people with mental illnesses.
Lyn Brown: I thank the Minister for that answer. I have consulted locally with constituents about the NHS in our area, and in general the feedback has been very good. I visited an excellent, fabulous facility for young people with acute mental health needs that is attached to my local hospital, but constituents have raised with me the issue of community support for young people with mental health needs. What progress is being made to provide community support for those young people in the area, and what I can tell my constituents on the issue?
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