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1 Apr 2009 : Column 270WH—continued

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
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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.

David Taylor (North-West Leicestershire) (Lab/Co-op): 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

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?

Mr. Kidney: 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.

David Taylor: 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.


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Mr. Kidney: 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.

Joan Walley (Stoke-on-Trent, North) (Lab): 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.

Mr. Kidney: 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.

Mr. Paul Truswell (Pudsey) (Lab): 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?

Mr. Kidney: 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,
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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.

Mark Fisher (Stoke-on-Trent, Central) (Lab): 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—the Member for Stoke-on-Trent, North (Joan Walley) about an independent inquiry and the review of case notes, does my hon. Friend the Member for Stafford (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.

Mr. Kidney: 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
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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:

That is an important concession by Mr. Moyes.

Mrs. Janet Dean (Burton) (Lab): 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:

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

Mr. Kidney: 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 the Member for Stoke-on-Trent, Central (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
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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,
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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

The Royal College of Nursing says:

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.

Mr. Robert Flello (Stoke-on-Trent, South) (Lab): 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?


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