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1 Apr 2009 : Column 276WH—continued
Mr. Kidney:
I said that in the case of my hospital, I want details of deaths, complaints and standards of care to be published. That is the sort of accountability that we want. We also want a management that allows staff to speak out and does not dictate that they must
keep quiet, and we want public and patient involvement from a group of people who get things done and link back to the public at large. Just as the nation’s interest will move on, so local interest will move on when people believe that their hospital is like every other hospital. I want people who remain dedicated and like Rottweilers on the hospital’s case. Those are my three suggestions for securing a sustainable future for a good hospital.
I want to finish by returning to the argument for a pubic inquiry. When I applied to the House for an urgent debate nine days ago, I gave four reasons for a public inquiry being justified. The first was to find out how the trust managed to pull the wool over the eyes—if that is what it did—of the regulator and others for so long without being caught out. Does the system rely on too much self-assessment? Are there things that the new regulator should know about the tricks and loopholes that people can get through if we are not careful?
The second reason for a public inquiry is that I want there to be proper rigour, supervision and authority about the independent reviews of patients’ case notes. An inquiry would be the right place to house the work that is being done on each of those cases. The third reason is the clinical failings at the hospital. What more, besides the understaffing that we know about and the lack of training that the report refers to, caused the hospital to fail so many times to deliver what the report regards as basic standards of care. The fourth reason is to find out what was wrong with the public and patient involvement. Was it just that the hospital did not do the sort of things that were done elsewhere, or is the system missing something that should be put in place? Those are the four reasons that I gave. I am not the only one saying that there should be an inquiry. Locally, the group that represents patients, Cure the NHS, says so. Nationally, the group that represents patients, the Patients Association, says so.
I received a briefing for this debate from the charity, Action for Victims of Medical Accidents, which says that there are still unanswered questions. It lists eight questions, and it is worth considering all of them. First, why did the Healthcare Commission fail to become aware of the problems at Stafford and delay intervening for so long? Secondly, why were the primary care trust and strategic health authority not aware of, or why did they fail to address the problems at Stafford? Thirdly, how did Monitor fail to recognise the problems at Stafford, and allow it to be given foundation trust status? Why did the different bodies fail to communicate with each other? Fourthly, why were the concerns and complaints of patients and relatives not properly addressed over a long period, and why did they not spark urgent action from any relevant body? Fifthly, what are the reasons for believing that existing and emerging systems of monitoring and regulating quality and safety, including the new Care Quality Commission, will prevent the same things from happening again? Sixthly, what measures have been taken to address the failings of individual board members, managers and other staff responsible? Seventhly, are the measures taken to identify which patients may have been harmed or died unnecessarily due to failings at Stafford adequate? Eighthly, what lessons can be learned at every level to prevent this from
happening again? That is a powerful set of questions. Will the Minister and the Secretary of State not reconsider the case for an inquiry?
Stafford hospital is our hospital—the hospital that my family and I, like hundreds of thousands of other residents of the Stafford constituency and surrounding constituencies in Staffordshire, go to for care and treatment. We are horrified by the report’s contents, confused that so many NHS organisations were involved but none made a difference, angry that the assurances given to us—given to me—by professionals over the past few years were completely misleading, and heartbroken for those who suffered when they should have been comforted and for those who died when they should have lived. We look to the Minister—I look to the Minister—to stand by us while we rebuild public trust and confidence in our Stafford hospital.
3.1 pm
Mr. William Cash (Stone) (Con): My constituents, too, are served by Stafford hospital and are devastated by what has happened and what has gone wrong, as am I. I place on the record my tribute to Julie Bailey and Debbie Hazeldine, who are here today on behalf of the patients’ campaign group, Cure the NHS, to the Patients Association and to Ken Lownds for their sterling work on behalf of the patients and victims of this terrible tragedy.
The Healthcare Commission report has fulfilled a useful preliminary purpose. Its investigation would undoubtedly shorten and reduce the cost of an independent inquiry under the Inquiries Act 2005, which is the subject of an early-day motion tabled by the shadow Secretary of State—my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who is present—and signed by about 150 Members of Parliament. The investigation has achieved a considerable objective, but I refer to an independent inquiry because it would be independent by virtue of statute.
There will be various reviews, such as the review of case notes and the Alberti review, which deals primarily with accident and emergency. The review by the Care Quality Commission, which the Prime Minister mentioned, raises questions about conflict of interest, in that its inquiry will include an analysis of the role of the strategic health authority, in which the person now in charge of the Care Quality Commission was involved.
There is also the primary care trust review. However, those reviews and any internal inquiries will not be independent in any real and effective sense, despite claims to the contrary—I expect some from the Minister today—because they will not take evidence on oath or compel witnesses, and there will not be compulsory production of papers or protection of evidence given by whistleblowers.
The catalogue compiled by the Healthcare Commission is incomplete, because many people have come forward since that report was produced, including patients and victims, but surprisingly still no whistleblowers. The latest information that I have from the campaigners is that, since the report was produced, potential evidence has emerged of two fatal errors in accident and emergency; there are still shortages of nurses; there is a lack of understanding of an early warning system for patient
deterioration; and a range of other matters are still going wrong. The Royal College of Nursing has already written to us with regard to a number of those matters.
No doubt the new interim chairman and chief executive will continue their work, but I stress that the Healthcare Commission report is only preliminary, and to put things right and deal with the cultural problem, which clearly has existed for a very long time and, some argue, goes back earlier than the period covered by the Healthcare Commission investigation, we need to know why this tragedy occurred. All those are reasons for an independent inquiry of the type that I have called for, which is supported by many Members of Parliament and by every newspaper in the Stafford area and indeed throughout the country.
Such a public inquiry was granted in 1984. I called for an inquiry as soon as I heard of the problems and deaths from legionnaires’ disease at the very same Stafford hospital when I was Member of Parliament for the Stafford constituency. The Prime Minister of the day granted an inquiry as soon as I called for one.
The scale of the problem outlined by the Healthcare Commission and the depth of the problems of governance and management in the history of this situation are reasons for an independent inquiry, which would sort out what happened and why. That would enable substantial lessons to be learned both nationally and locally, and the Healthcare Commission itself acknowledges in its report the need to draw national lessons from what has happened.
There are many fundamental reasons why an independent inquiry is essential, and the Minister, in replying to the debate on behalf of the Secretary of State and the Prime Minister, should reflect carefully on the fact that if he refuses to hold such an inquiry, that will be a reflection on his judgment and integrity. For the reasons that I am about to explain, in addition to what I have already said as a matter of principle, I believe that failure to hold an inquiry would amount to a cover-up, and furthermore that only a public inquiry would satisfy the points that I am about to make.
Those reviews are not independent in the sense in which I have explained independence. They are scattergun reviews, with different terms of reference and timelines for reporting, and they do not allow the compulsion of witnesses and papers. That is a vital ingredient to get to the bottom of this tragedy. If the Government refuse to have an independent inquiry under the 2005 Act, that will be a local and national disgrace.
Failure to hold a public inquiry would suit the trust, the strategic health authority, the Care Quality Commission, the board, the Secretary of State and the Prime Minister, but it certainly would not suit the patients or victims and it would not be right for the future of the hospital. A public inquiry would not only be independent and get to the bottom of what went wrong at the hospital, but it is needed for the following reasons.
The Healthcare Commission itself agreed that Mid Staffordshire NHS Trust had “fully met” all existing national targets between 2006 and 2008. The obsession with targets was one reason for the failure of the trust board. Furthermore, in 2006-2007, the trust met its targets despite disturbingly abnormal mortality rates. The Healthcare Commission report dated those as far
back as 2003-04, and the Commission for Health Improvement criticised the quality of care as early as 2002. Therefore, the Healthcare Commission report of itself does not go back far enough. That is a reason for having an inquiry into what happened.
Dr. Foster Intelligence, which monitors mortality rates, put the trust as the eighth worst acute trust in 2008 and the second worst in 2007. The strategic health authority—whose chairman during much of that time is the new chief executive of the Care Quality Commission, established today—received mortality reports in 2007 and 2008. I called for an independent inquiry and raised my grave concern when I said to the Prime Minster and the Secretary of State that I believed that there was a conflict of interest—I said that on the Floor of the House; it is in Hansard—because Cynthia Bower was chairman of the strategic health authority, but is now chief executive of the Care Quality Commission.
On the “Today” programme this morning, Baroness Young of Old Scone—who has taken over the chairmanship of the Care Quality Commission, which the Prime Minister said on 18 March would take over the review of the Mid Staffordshire problem—said in reply to the question that Cynthia Bower appeared to have a conflict of interest that she had examined what Cynthia Bower did during the period in question and was satisfied. That is a travesty, given that in the minutes of a meeting of the strategic health authority board on Tuesday 18 March 2008, which I have with me, Cynthia Bower said that
“there appeared to be nothing to indicate anything out of the ordinary was taking place on mortality.”
Baroness Young said that the tragedy at Mid Staffordshire had eluded everybody, whereas Mid Staffordshire had been ignoring what patients and victims were saying.
On the programme, there were also exchanges with the representative of the Patients Association in relation to the question of self-assessment. That is dealt with in the Healthcare Commission report, which came through a few days ago. It is shown that it was Government policy to revert to local assessment, rather than external assessment, in the legislation setting up the commission. The very fact that that has been so disastrous and the strategic health authority has not done its job properly shows that the Care Quality Commission will not be able to deal with those questions, which is yet another reason for an independent inquiry.
Indeed, I raised many of those matters with the Baroness a few days ago at a meeting in one of the dining rooms in the House of Commons. In the interview this morning, she said that what happened at the trust had eluded others and that she was satisfied with the outcome, but I do not see how that squares with what I have reported from the minutes.
Furthermore, there is the problem of self-assessment. The Care Quality Commission will not have the same function as the Healthcare Commission of reviewing complaints at a local level, and that is made clear from the report to which I have just referred. There is also much in the report about hearing the voices of patients, but the campaign group Cure the NHS has a catalogue of complaints that have not been resolved. Indeed, I am informed that there were no formal contacts between the hospital and the campaign group until it was far too late.
The Healthcare Commission end-of-term report emphasises that effective regulation combines listening carefully to users and staff and engaging with local patients’ groups, and that is included in the new Care Quality Commission’s statutory objectives. Even with the statutory objectives in the new legislation, can there possibly be confidence in the Care Quality Commission, given the tragic circumstances that have arisen at the trust and the failure of the SHA, which did not even visit the trust, not to mention the conflict of interest that I described?
Stafford borough health scrutiny committee was given information relating to mortality rates at its meeting with the trust on 13 August 2008, and I have that information with me. At the presentation, the trust claimed that those rates were “consistently below national average”, but that seriously differs from other evidence, including that from the Healthcare Commission. The presentation also referred to independent reviews of mortality rates by the SHA and the university of Birmingham, none of which appear to have been accurate or substantiated. There were also extremely unreliable statements about the control of infections and MRSA—methicillin-resistant Staphylococcus aureus—and claims that there was a positive review by the Department of Health cleaner hospitals team. Finally, Monitor itself has clearly not performed its functions effectively in relation to the failings at the trust and the granting of trust status.
All in all, there has been a systemic failure internally and externally at every point on the compass by a wide variety of bodies charged with investigating and providing analysis, statutorily or otherwise. For the reasons that I have given, no confidence can be placed in the arrangements that the Secretary of State has put in place in relation to the trust, because they lack the fundamental elements of real independence, compulsion on oath and in relation to papers, and the protection of whistleblowers, which only an independent inquiry of the kind that I have called for can provide. On receiving notice of the Healthcare Commission report, which had been leaked, I went straight out to the public and called for an independent public inquiry, and I call on the Secretary of State to accept such an inquiry in the light of my submissions.
There is no answer to this question other than an independent inquiry—the people of my constituency insist on one, the people of neighbouring constituencies insist on one and every national, regional and local newspaper insists on one. I can think of no reason why the Secretary of State and the Minister should not agree to such an inquiry. If they do not, the Government’s integrity will be at stake.
3.13 pm
Dr. Tony Wright (Cannock Chase) (Lab):
I should not be here today—I should be at the funeral of a lady who died in Stafford hospital a few days ago. I phoned her husband last night to ask whether he would prefer me to go to the funeral or to come here, and he said that he would rather that I came here. I asked him about the care that his wife had received on ward 1 at the hospital, and the words he used were “absolutely brilliant”. Indeed, he thought that it was so good that he and his family had been into the ward to thank the staff for looking
after his wife, and he said that he intended to write to the chief executive to put on record the care that they had shown her.
I say all that partly because that lady’s husband asked me do so, but also because much of what we say on this issue is necessarily extremely critical—how could it not be? It is worth inserting, therefore, the fact that there are clearly many people in the hospital who are doing their damnedest in difficult circumstances to provide good care to patients.
I have been through all my files again, looking at these dreadful cases, which go back more years than does the Healthcare Commission report. I would have read some of them out in the Chamber had there been more time, but I will mention just one, which relates to a former nurse on ward 10 last year. I do not have time to read out her experiences, although I would have liked to do so. However, she concludes:
“So many old people, lying dependent on too few staff was for me frightening. For them, many of whom were deaf, partially blind or crippled, they must have felt that they had been completely abandoned. I cannot believe that supposedly fully trained nurses, with vocation, care and compassion gain any satisfaction from such an abysmal situation”.
The fact that that was written by a former nurse, who is describing her own experiences, is particularly telling.
We all knew from the cases that we were dealing with that something was going seriously wrong. When we finally got an inquiry because the figures had been picked up by Dr. Foster and then by the Healthcare Commission, and because of the persistence of the patients’ group, I wrote to that inquiry in April 2008 to say that it should look at the pattern of complaints over the years
“as these have highlighted systematic care issues that I believe have needed attention”.
I think we all felt that. The tragedy is that it finally took a Healthcare Commission report to bring to light things that we knew were happening.
Perhaps the worst thing is that each time we worked with families to pursue complaints, we got letters back telling us that those complaints were being attended to and that action plans were being put in place. Indeed, I have records of those letters with me. I found one letter particularly chilling because it was written by a sister who had investigated a particular case:
“I apologise for the distress caused to”
“and her family and that she found the staff uncaring. We continually try to update our staff’s knowledge and awareness in customer care and all staff have attended Confidence in Caring study days which addresses issues such as customer care”.
When I read and re-read that, I had to wonder what state we had arrived at. We are told that nurses have to be sent on customer care courses to learn that care for patients is part of the job that they are engaged in. The trust’s responses were unsatisfactory and it is a tragedy that it finally required a Healthcare Commission report to prove that.
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