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1 Apr 2009 : Column 288WH—continued
One might say that it is our and Ministers’ job to determine policy, but sometimes Ministers are in denial. As the hon. Members for North Norfolk (Norman Lamb) and for Oxford, West and Abingdon (Dr. Harris) said, the Healthcare Commission’s report explained in detail how the target culture of downward pressure and tick-box target adherence contributed to the failures at Stafford general. Why then did a Minister, on the day that the report was published, say that it had nothing to do with targets? I think that Ministers are in denial about the conclusions set out clearly in the commission’s report. They have commissioned further reviews. For
instance, they have asked Professor Sir George Alberti to visit the hospital to examine compliance with the requirements for best practice and treatment in emergency care. However, he will not question the target culture, because, for years, he has been the national clinical director inside the Department of Health responsible for the implementation of the target culture. There is no independence in that sense.
If the further reviews initiated by the Government are not independent, we cannot expect them to arrive at answers that command confidence. Patients and relatives so much affected, distressed and hurt by what has happened demand—and we should accept their demand—that they be given the opportunity to be heard; to see all the facts presented in public; to see behind the conclusions and evidence set out in the commission’s report; to find out what the policy and regulation structures were that led to this situation, and why it happened; to secure closure; and, more than that, to contribute to the increased confidence that this will not happen again, either at their hospital or at somebody else’s. Last week, I visited Stafford and spoke with Julie Bailey and others from Cure the NHS. From that conversation, I feel strongly that their underlying objective relates not just to what happened to them and their families, but to ensuring that quality of care for patients is, and remains, the absolute focus of NHS staff. We must put in place a mechanism, through an independent inquiry, to ensure that nothing gets in the way of that.
The hon. Member for Cannock Chase rightly raised the point that, day by day, in Stafford general hospital, patients are treated well—excellently, in many cases. There is nothing paradoxical—certainly not to me and those who know the NHS well—in the proposition that some patients in the same hospital are treated well, but others not. One can literally go from one ward, where the standards of cleanliness, hygiene and care are very high, to another, where they are not. The Minister might say, “Well, that is all about leadership”—of course, it is—but at Stafford general hospital, precisely the opposite set of circumstances applied to those in some of the hospitals that have responded best to the downward pressure for improvements in emergency services. In the very best hospitals, including some that I have visited, the response to that pressure has been to re-engineer the whole of their emergency activities so as to maintain high-quality care, while delivering on the Government’s targets. In others, however—unfortunately, Stafford general is one of them—there has been no effort to re-engineer those activities to deliver and sustain quality through the appointment of sufficiently well trained staff. They clearly did not see the need for that. The Healthcare Commission clearly identified the nature of the problems with Stafford general’s emergency department and the subsequent emergency admissions to other wards.
If every hospital was to succeed in delivering high-quality care, there would be no need for a regulatory system. If every hospital was to perform to the best of its potential, there would be no need for performance management. If every hospital could have any number of patients referred to it, without constraint or control, and still deliver high-quality care, without scrutiny and accountability, there would be no need for NHS health care commissioners. But we need all those things. None
of them can be relied on to happen automatically. A worryingly large number of bodies are involved in the commissioning process. That primary care trusts, acting as commissioners, appeared to be concerned only with cost and volume, and not with quality, is a condemnation of the level and nature of the commissioning being undertaken by PCTs. When general practitioners referring patients were asked by the PCT whether there was a problem, they said, “Yes, we have many concerns.” Clearly, however, they had no influence, which tells us something important about the failures of the local commissioning process.
The hon. Member for North Norfolk is right that there is far more to this story than is in the Healthcare Commission’s report, which is entirely condemnatory of the role of the West Midlands strategic health authority. It was responsible for performance management and was told regularly by the commission about its concerns and the lack of co-operation from the Mid Staffordshire NHS Trust, but the SHA did not act or intervene. When the opportunity arose, it did not tell Monitor about the concerns before foundation status was granted. That tells us that far greater examination is needed of the role and influence of SHAs in relation to NHS trusts and, in particular, in this case, the then chief executive, who is now the chief executive of the Care Quality Commission. That needs to be independently examined.
Last Thursday, I visited the Mid Staffordshire NHS Foundation Trust. Despite the improvements made and the substantial recruitment of additional staff, there remains, inside the trust, a lack of acceptance of the failings that occurred and of an understanding of what is required to secure the confidence of the public that it serves. We have all learned, in many circumstances, that to learn from what has gone wrong is the starting point of getting things right in the future. On the day of the report, the interim chief executive, on behalf of the trust, wrote to hon. Members and members of the NHS foundation trust. In that letter, he neither accepted the report in full, acknowledged in detail the scale and severity of the failings, nor explained how the hospital’s underlying cultural problems, the responsibilities of front-line clinicians or engagement with patients and the public would be altered. The letter literally just said, “This is what we’ve done. Here are the additional staff we’ve recruited. In effect, it’s time to move on.” It is not good enough for the hospital to say that it is time to move on and that it will improve things in the future. We need to understand what happened, and Ministers must accept that we can only do that through an independent inquiry.
3.50 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate my hon. Friend the Member for Stafford (Mr. Kidney) on securing this debate and on giving hon. Members an opportunity to discuss in more detail the very serious findings of the recent Healthcare Commission report. I will endeavour to answer the questions that he and other hon. Members have raised in the short time that we have left. If that is not possible, I will write to him and to other hon. Members after the debate. The Secretary of State and I have made it clear that our doors are open to anyone who wants to raise issues with us over the forthcoming days and weeks.
I will not go over the details of this report again. It is well known to hon. Members, who have repeated many of its dreadful details today. Suffice it to say, it represents a catalogue of catastrophic management and governance failure at Stafford hospital. My hon. Friend is right in his analysis of the chronology before 2007. One of the reviews announced by the Secretary of State—I will talk about it in more detail in a moment—will look at exactly what happened before 2007.
What is clear from the Healthcare Commission report is that it was only when it developed a more sophisticated approach to analysing mortality rates in hospitals in 2007 that it was alerted to the possibility of a serious potential problem at Stafford. My hon. Friend asked for an assurance that the hospital is now safe. The Healthcare Commission itself has given a public assurance that emergency care at the hospital is now safe. As an extra assurance, we and Monitor have asked Sir George Alberti, our national clinical director for urgent and emergency care, to conduct a review of the trust’s procedures for emergency admissions and treatment. He will also examine its progress against the recommendations made by the report.
My hon. Friend also asked whether Professor Alberti’s review can be widened. It is understandable that the review should focus on the emergency care and related services that were the focus of the Healthcare Commission’s report, but we have made it clear that there should be no no-go areas for his inquiry. He is free to go anywhere and ask any questions he likes. He would actively welcome input from hon. Members and members of the public. I can assure my hon. Friend that the findings of the report will be made public. Professor Alberti will be happy to discuss them with him, other hon. Members and members of the public.
Mr. Cash: Will the Minister give way?
Mr. Bradshaw: I ask the hon. Gentleman for his forgiveness, but I have seven minutes left to answer many questions. I will get to the questions that he raised, and I do not intend to give way.
The second piece of work that has been launched by the Secretary of State is investigating what went on before the Healthcare Commission’s investigation and why alarm bells were not ringing earlier. It will look specifically at the roles of the primary care trust and the regional strategic health authority. It will be conducted by Dr. David Colin-Thomé, the national clinical director for primary care, and, again, it will have no no-go areas.
I come now to the third piece of work. Hon. Members asked for an assurance that no other accident and emergency departments in the country were running their operations in the same disastrous way as Stafford. The Healthcare Commission has already said that it has rechecked all of those hospitals with what are called outlier hospitalised standard mortality rates, and is satisfied that they do not give cause for concern. NHS chief executive David Nicholson has also written to all NHS organisations, drawing their attention to the Stafford report and requiring them to satisfy themselves that similar failures cannot occur within their own organisations.
The fourth piece of work, in response to the commission’s report, is that the trust is offering an independent review of patients’ records for anyone who would like it. My hon. Friend asked me how that work was progressing.
I am informed by the new management of the hospital that they have established a helpline, that they have already had 40 inquiries and that they are setting up a group of independent clinical experts to look at and examine the records of anyone who wishes that to happen.
My hon. Friend asked what personnel changes were happening, had happened and would happen at the hospital. I think that he recognises that personnel decisions at a foundation trust are for the board of that trust and for Monitor. Most of the old board, including the chair, have gone without any severance payment. There is a new acting chair, chief executive and medical director.
The previous chief executive, Martin Yates, has been suspended, while an independent investigator examines his role. The new acting chair is also examining the overall past governance and management of the trust. We have made it clear that the new management must make decisions that mean that the hospital can command the confidence of the public and that wrongdoing is dealt with. Moreover, there should be no rewards for failure. Personnel decisions must be swift, within the law and follow due process. Summary dismissal may provide people with some initial satisfaction, but that is likely to be short-lived if it is successfully challenged in court or at industrial tribunal.
I agree with my hon. Friend that boards should be open and should meet in public. I understand from the new chair of the Stafford trust that the board will meet in public. Moreover, I point out to my hon. Friend that the code of governance for foundation trusts encourages directors to promote openness in decision making and in the processes at meetings.
A number of hon. Members have made substantive calls for a public inquiry. The Secretary of State promised to give the matter further consideration after receiving representations from my hon. Friend and patients’ groups during his visit to Stafford hospital last week. He accepts that public inquiries can be an important mechanism to establish independently the cause of a problem or disaster. However, in this case, the Healthcare Commission, the independent regulator expressly established by Parliament to scrutinise and investigate the NHS, has conducted a full investigation and produced a detailed report laying bare the failures at Stafford hospital. My right hon. Friend believes that a public inquiry would add little more to our understanding, be time-consuming and, crucially, distract the new management and staff at the hospital from focusing on further improving the quality of care for local people.
In a letter to my hon. Friend the Member for Cannock Chase (Dr. Wright), Sir Ian Kennedy spells out why he does not think that a public inquiry would be helpful. It was Sir Ian, after all, who chaired the Bristol public inquiry. Sir Ian says that he would be happy for his letter to be circulated more widely. However, if my hon. Friend or anyone else believes that there are issues or lines of inquiry that have not been addressed by the Healthcare Commission report or the subsequent reviews, the Secretary of State would be only too happy to consider them.
I urge anyone who has outstanding concerns or criticisms to make those known to the Alberti and Colin-Thomé reviews and to the new regulator, the Care Quality Commission, which begins its work today. The Care
Quality Commission said that it will re-investigate Stafford hospital before September to ensure that improvements have been made.
I fundamentally disagree with some of the points that were made by hon. Members on targets. To try to blame what happened in Stafford hospital on targets is to let the management and the board off the hook. Hospitals up and down the country ensure that people do not have to wait more than four hours in accident and emergency, which is a perfectly reasonable standard, while at the same time providing safe and high quality care. The vast majority of hospitals in England meet the accident and emergency waiting target, and there is a very strong correlation between hospitals that perform well on the A and E target and their overall quality of care.
The new consultant at the A and E department in the Mid-Staffordshire NHS Foundation Trust told the Secretary of State last week:
“When you get the quality right the targets look after themselves.”
I could not have put it better myself.
The hon. Member for North Norfolk (Norman Lamb) raised the issue of the coroner. Concerns have been raised in the report by a number of the families. My right hon. Friend has spoken to the Secretary of State for Justice about that, and officials in my Department have spoken directly with the coroner. He has made it clear that he is happy to facilitate the exchange of information with all of the ongoing reviews. He has also said that he would be happy to receive any application from a bereaved relative to have individual case notes examined.
I hope that I have managed to address most of the points. I know that I have not addressed them all, but I will write to hon. Members. I urge hon. Members to stay engaged with the new hospital leadership and the ongoing reviews that have been announced. I stress again that my door and that of the Secretary of State will be open to them over the coming days and weeks.
Home Improvement Agencies
4 pm
Mr. David Drew (Stroud) (Lab/Co-op): I am delighted to have the opportunity to introduce the debate and to see the Minister in his place. He will, I hope, have some interesting things to say. I also welcome my hon. Friend the Member for Stoke-on-Trent, North (Joan Walley). She may have something to say, too, and I know the she has taken a long-term interest in these matters, especially through her involvement with the associate parliamentary group for environmental health.
I make no apology for talking first about my local situation, because that is how the issue came to my notice. I have an interest to disclose: I have been a member of the board of Care and Repair Stroud for some 21 years. I retain an interest, although I am not quite as active as I was in previous days—since being elected, I have taken on many other responsibilities.
Jane Creed, the manager of Care and Repair Stroud, contacted me initially on 16 March. She was very worried about the financial situation faced by the agency and told me that its access to grant was about to be cut in half. Last year, it was £960,000 and the agency was expecting that amount to be considerably reduced. The money has been allocated to Stroud district council. Some of it goes to other sources, but most will find its way—through the private sector housing renewal grants—to Care and Repair Stroud.
Jane pointed out to me the fact that that will have a major impact on the agency because its fee income depends entirely on private sector grant renewal moneys. Indeed, the danger is that, as well as losing the fee income, we are unlikely to realise the opportunity to find alternatives, given the short time we have to respond. Rightly, she has asked me to ask the Minister this question: where has the money gone? I think that we know where it has gone—to regional development agencies for new build—but this is somewhat disheartening, to put it mildly. The impact on the renewal and repair sector will be dramatic unless we can see this as a one-year event. I would welcome some assurance from the Minister that the money will find its way back into the sector.
Joan Walley (Stoke-on-Trent, North) (Lab): I congratulate my hon. Friend on securing the debate. Does he agree that we have an urgent agenda on housing, homes and public health, particularly in view of the G20 talks that are taking place today, and that we need urgently to look at how we bring private sector homes up to standard? No amount of new building can compensate for the lack of improvements in energy efficiency and decent homes standards in the private sector. For that reason, does he agree that it is vital to keep the funding where it is needed to achieve the improvement in existing housing stock, whatever else may need to be done to create new housing stock?
Mr. Drew: In a nutshell, my hon. Friend has described why I am introducing the debate. This is at least the fourth time that I have raised in the House the issue of home improvement agencies, either in their own right or as part of the supporting people strategy. I wish to add to what she said to explain why this is a crucial issue, even if it does not necessarily get as much publicity as it deserves and should receive.
Jane subsequently contacted me late last month to say what more she had found out. As she stated, she is very much in favour of our strategy, which is a good one. As I suggested, the Government are not much congratulated on it, but we should be proud of it. However, the problem is this: the strategy is right, but the money does not always go where it should to deliver on it. By the time Jane contacted me, she had found out in yet clearer terms that the private sector renewal grants will be greatly depleted from this year on, certainly until April 2010. That is why we need clarity from the Government.
I want to mention two things on the back of that. They are not in any way bad news, but we need further clarity. First, money is finding its way through to the handyperson scheme—I will say more about that when I speak more generally on the matter—but it is not always clear how it will be spent. That tends to rest with the county council. In two or three-tier local authorities such as ours, there is some inter-local authority rivalry over how the money will be spent.
Secondly, we have the disabled facilities grants. They are being increased by the Government, but it is not always clear how the money works its way through the system. Certainly, there is some time lag in the money being made available to home improvement agencies such as Care and Repair Stroud. Will the Minister tell us how we can give things a boost and get the money through the system more quickly?
On the more general situation and to put things in context, home improvement agencies work on older people’s homes or houses owned by disabled people. To show how important they are, it is estimated that there are some 6.55 million properties in the private sector in the non-decent homes category, compared with only 1.14 million in the social rented sector. Privately-owned homes are twice as likely to have category 1 hazards compared with social housing. Some 2.5 million homes have at least one type of the fall hazards—we know them only too well—that bring many people into our hospitals, and 2.2 million have an excess cold hazard problem.
Virtually the only practical housing help available to disadvantaged home owners is the services offered by home improvement agencies. The importance and value of the agencies was emphasised by the Government in “Lifetime Homes, Lifetime Neighbourhoods: A National Strategy for Housing in an Ageing Society”, so I take it as read that they see the agencies as an important part of the fabric of home improvements. They are not part of the decent homes standard, but they are the private sector equivalent. It is frightening but well known that the oldest people tend to live in some of the oldest property. That doubles what is a particularly acute problem.
Home improvement agencies give information and advice, and help around 240,000 people each year. They carry out 41,000 building jobs with a total value of around £90 million. A further 105,000 minor jobs are dealt with by the handyperson services. They undertake about half the work arising from disabled facilities grants, which works its way through via local authorities. Therefore, their future funding is of great significance. I hope that the debate enlightens people on that and that the Minister offers some clarity and reassurance.
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