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That this House calls for an independent inquiry under the Inquiries Act 2005 into the failings of the Mid Staffordshire NHS Foundation Trust.
I understand that the Secretary of State is with the World Health Organisation in Geneva. He spoke to me last week about that. We entirely accept that that is the proper thing for him to do, so I welcome the Minister of State, the hon. Member for Exeter (Mr. Bradshaw) to move the amendment and speak on behalf of the Government.
This morning I visited Stafford again, the fourth time that I have done so in two months. I wanted to make sure that I had had an opportunity to talk with those who have been most closely concerned with the failings in care identified at Stafford general hospital, and with efforts to ensure that lessons have been learned. I wanted to discuss with them their view of the reviews published at the end of April by Professor Sir George Alberti and Dr. David Colin-Thomé on behalf of the Department of Health.
The conclusion reached by those to whom I spoke, by us and by many Members across the House who know most about these issues is that those reports to the Department of Health were not independent, were not sufficient, and did not go beyond a superficial examination, in Dr. Colin-Thomé’s case, of the role of external agencies. In Professor Sir George Alberti’s case, the report was no more than a snapshot of what is happening in relation to Stafford general hospital.
In sum, the reports do not go beyond the Healthcare Commission investigation and report to set out clearly, for the benefit of the public in Staffordshire and south Staffordshire, not only what happened, but why it happened and why the organisations and the senior executives in the health service who were charged with managing the trust’s performance, with monitoring and performance-managing the trust at a senior level, and with its performance assessment failed in their task of ensuring that the lamentable failings in the standards of care at the trust were identified earlier and stopped.
Lembit Öpik (Montgomeryshire) (LD): Although I very much agree with what the hon. Gentleman has said so far, he said that the people of Staffordshire would be concerned about the matter. Is he aware, as my constituent Trudy Hill has pointed out, that the gravitas of it is exacerbated by the fact that it was of national importance? Many of my constituents from Montgomeryshire also depended on the services of Staffordshire, especially the specialist services. I imagine that the large turnout for the debate reflects both the hon. Gentleman’s concerns and those of people in a radius of well over 100 miles of the trust.
Mr. Lansley:
I understand the hon. Gentleman’s point. Forgive me, Mr. Deputy Speaker, because I should have referred not only to south Staffordshire, because, of
course, the issue goes further. Indeed, the issues under discussion range widely: many people, wherever they live, were shocked by what they read in the Healthcare Commission’s report and wanted to know not just what happened but why it happened; and people in the hospital knew what was happening but were not listened to when they tried to do something about it, or they did not have an opportunity to do so.
Michael Fabricant (Lichfield) (Con): Will my hon. Friend give way on that point?
Mr. Lansley: If I may, let me just make this point. The Government promised an oral statement on the two reviews that were published on 13 April, and I wish not that we had had to table this motion, but that the Government had made an oral statement and accepted that the reviews did not answer the questions before us, and that the Secretary of State had come to the House and said that he was going to institute a public inquiry on the terms we seek. I am sorry that we have had to move the motion, but it now seems to be necessary.
Michael Fabricant: Does my hon. Friend accept that people in Staffordshire who have been personally affected by the matter ask for an inquiry, which needs to be independent, not to apportion blame, but to ensure that something like this can never happen again—not just in Staffordshire hospitals but in other hospitals? Rightly or wrongly, they believe that if the inquiry is not independent, it will be a whitewash.
Mr. Lansley: I understand exactly what my hon. Friend says, and he knows the matter very well through his constituency and his constituents who visit Staffordshire general hospital and those who, no doubt, work there. His point is right, because Peter Carter, general secretary of the Royal College of Nursing, visited Staffordshire general a few weeks ago and met nurses from throughout the hospital. He told me that the RCN itself now wants a public inquiry. Although it represents the largest group of staff employed at the hospital, it does not consider a public inquiry being for one minute a distraction or diversion from the delivery of the best quality of care in that hospital. From its point of view, finding out not only what happened but why, and learning those lessons for the future at Staffordshire general and in the wider NHS community, is absolutely vital. The RCN was quite right to make that point.
Mr. Patrick McLoughlin (West Derbyshire) (Con): My hon. Friend knows, because I have told him, that my mother died at Staffordshire general hospital just over 15 years ago. She received fantastic treatment and care at the hospital, and, importantly, many people who have worked there for a very long time and dedicated their lives to giving public service to the health service are, whether we like it or not, blighted by that period. For their sake as well as the sakes of the people who rightly feel most aggrieved, a public inquiry must take place.
Mr. Lansley:
I am very grateful to my right hon. Friend, who is absolutely right. I hope that he and Members from all parts of the House will understand that I bow to no one in my support for national health service staff, for what they do and for how they do it.
However, they, like anyone, know that the performance and failings of organisations are often systemic rather than personal. We therefore want not only to identify personal responsibility on the part of senior executives, a point to which I shall return, but to understand the systemic problems that meant that good staff, trying to do their best, found that they were unable to do so, because of either staffing and financial decisions, or a lack of performance management and scrutiny by other organisations.
My right hon. Friend makes an important point. One clear example of what the published reviews lack is that Dr. Colin-Thomé, in his report, addressed three recommendations to the Department of Health, as though the Department has serious responsibilities to ensure that the system must change, but no part of it to whether the Department, in the past, took its responsibilities seriously and discharged them. It is as if the Department did not exist before now—that, somehow, it is the solution for the future but did nothing in the past. The Department, however, did a great deal in the past that may have contributed directly to the matter.
Mr. William Cash (Stone) (Con): Will my hon. Friend give way?
Mr. Lansley: I shall of course give way in a second, but let me clarify what I mean. For example, it is abundantly clear that strategic health authorities and primary care trusts, whatever their failings, were significantly damaged by NHS reorganisations and the utter chaos that flowed from them. The Department and the previous Secretary of State were directly responsible for sending the foundation trust’s application to Monitor, but, in Dr. Colin-Thomé’s report, there was no evidence of the scrutiny that should have been applied, or any reason why it was not. The appointment to SHAs and PCTs of senior staff, and their performance, is a responsibility of the Department, but that was not discharged. Indeed, I shall come on to the central issue of targets and the responsibility of the Department.
Mr. Cash: My hon. Friend quite rightly refers to the past and its connection with the present. He will also be aware that the current NHS chief executive is David Nicholson, who, at the critical time, was chief executive of Shropshire and Staffordshire strategic health authority and West Midlands South strategic health authority, and that there is a direct connection between those two matters.
Mr. Lansley: I am grateful to my hon. Friend, who understands these matters extremely well. He is right about that, but let me anticipate what I was in any case going to say. Dr. Colin-Thomé points out how the SHA and the PCT failed to meet their responsibilities, saying that the
“PCTs past and present and SHAs past and present do not appear to have taken notice of signs that were present in the survey data and in complaints that indicated poor patient care.
Evidence of poor care has emerged that was not collated or challenged by the PCTs or SHAs at the time.”
We know from the Healthcare Commission’s report that clinical governance issues that were raised in 2002, and on which its predecessor organisations commented
adversely, were exactly the same in 2008. Up until the trust became a foundation trust, the SHAs were responsible for the scrutiny of its performance, and they, in particular, clearly failed to address themselves to the quality of care that the trust provided—to the point at which, in March 2008, when the SHA board received the university of Birmingham’s report on data, it said that
“there appeared to be nothing to indicate that anything out of the ordinary was taking place on mortality.”
There was a woeful failure on the part of the SHA and the PCT. Notwithstanding the fact that Dr. Colin-Thomé makes it clear that there was such a failure, there is no indication in his review of who was responsible. On the issue of who was responsible, we are talking about David Nicholson, for about a year, who is now chief executive of the NHS, and Cynthia Bowers, subsequently, who is now chief executive of the Care Quality Commission. Standing at the Dispatch Box, I do not know whether I can say that they were directly—personally—responsible for those failings in a way that should be substantively criticised; I do know, however, that the motion is not about criticising any individual, but about establishing a public inquiry. However, I do not want anyone to think that, by calling for an inquiry, we have neglected the fact that the proper purpose of such a public inquiry is to find out whether two of the most senior people in the NHS, with responsibility for its services, have shown that they are credible or capable of such responsibility.
Mr. Cash: The minutes, which I have with me, will demonstrate some of the connections to which my hon. Friend refers.
Mr. Lansley: Yes. I look forward to hearing from my hon. Friend if he manages to catch your eye, Mr. Deputy Speaker.
I know that other colleagues across the House want to contribute, so I shall try to be quick. I want to illustrate further why I feel that the reviews thus far have not answered the questions that must be answered. In his report, Dr. Colin-Thomé says:
“I feel very strongly that a lack of good patient engagement is the key to why Mid Staffordshire hospital trust continued to provide poor care for a protracted period of time.”
That may well be true, but is there any analysis that goes beyond that? Is there any analysis of how the Government, through the abolition of community health councils and the emasculation of patients’ forums, led to a reduction of patient engagement in a way that was a tragic failure? Is there any examination of how foundation trusts are engaging or failing to engage with the public?
The many of us who represent foundation trusts believed that they should be a mechanism for engaging the public, as members of the trusts, more effectively. Clearly, that mechanism failed in this case, but Dr. Colin-Thomé gives us no sense of that. Frankly, all we have from him is what seems to be no more than a bland expression of hope that local involvement networks, or LINks, which were set up by the Department under recent legislation, will somehow be better at all this—without independent powers to investigate, follow up complaints or act as an advocate. In his report Dr. Colin-Thomé seems to think that LINks will be useful, but he did not meet LINks representatives in Stafford, so it is all pure pie in the sky.
Mr. John Gummer (Suffolk, Coastal) (Con): Will my hon. Friend make it clear that the investigation would be of considerable importance to the whole country? In my constituency, we face the imposition of a new system that will rip proper, emergency heart care from Ipswich hospital without there having been any discussion whatever. My constituents are left having to go from Leiston to Papworth if they are to have emergency treatment. Such a situation arises if there is no discussion with patients and no concern for them. We need the investigation not just for Staffordshire, but for the whole country.
Mr. Lansley: I am grateful to my right hon. Friend. As he knows, I have visited Ipswich hospital to discuss the removal of its maxillofacial treatment services. I am aware of what my right hon. Friend has described. If he and other colleagues permit me, I will make it my business to visit Ipswich hospital to discuss the issue with its representatives. The services that patients would receive at Papworth hospital would be among the finest anywhere in the world, as it is in my constituency. However, that is not to say that we do not believe that such services should be provided in more accessible locations if they can be and if they are of good quality.
Norman Lamb (North Norfolk) (LD): Does the hon. Gentleman share my concern at the apparent drift towards more secrecy for board meetings at foundation trusts? More and more foundation trusts are routinely excluding the public and hospital governors. That is a trend in the wrong direction; there should be more openness and more accountability.
Mr. Lansley: I do share that concern. In that context, I should like to make another important point on which a public inquiry would further add to our knowledge. Just before the Healthcare Commission report was published, Martin Yeates, then chief executive of Mid Staffordshire NHS Foundation Trust, “stepped down”—that, apparently is a term of art. After the commission’s report was published, the board took the view that he should be suspended. It instituted an investigation by Peter Garland, a senior former NHS chief executive. Apparently, Mr. Garland has reported to the trust board and told its members the extent to which he believes Mr. Yeates met or did not meet his duties to the board and the trust. That report, however, has not been published and, as I understand it, the trust board does not intend to publish it.
Yet on Friday afternoon—we all know what happens to Friday afternoon press releases—the board announced that Mr. Martin Yeates had tendered his resignation, which the board had accepted. As a consequence, Mr. Yeates will receive his notice period; in addition to his two months’ pay on gardening leave, he will get six months’ pay. He has effectively been put beyond the scope of disciplinary action, unless a breach of duty can be demonstrated. Clearly, that will not happen unless all the evidence is brought out in a public inquiry. I am not accusing Mr. Yeates of anything, but we are not being given access to any of the information on which a judgment can be based.
I turn to another important point, to which Dr. Colin-Thomé referred. It is about complaints. Again, Dr. Colin-Thomé did not put forward any suggestion about what should be done. All he said was that the Government’s reform of the complaints system in recent legislation
will somehow make things better. There is no evidence to suggest that. On the contrary, there is the idea that the new Care Quality Commission will not have a responsibility in the scrutiny of second-stage complaints; that will disappear off to the ombudsman. That undermines further, as compared with the past, the ability of Care Quality Commission performance assessment to be combined with intimate knowledge of what is happening inside a trust.
Frankly, there are already questions about the extent to which the Healthcare Commission acted; second-stage complaints should have been getting to it, but they were not. Where were the complaints going? That is the interesting question. The Healthcare Commission report says that some of them were going to strategic health authorities, others to the National Patient Safety Agency and some to the Healthcare Commission itself—there was no rhyme or reason about it. The system in relation to the complaints is dysfunctional, and the Healthcare Commission, which most needed to know—its statutory responsibility is to investigate when patients’ quality of care is being compromised—did not know. If it did, we need to understand to what extent it was acting on the complaints.
Individual complaints were investigated by the commission; one has come to me. The commission concluded that there had been gross professional negligence and demanded that Staffordshire hospital prepare an action plan in response within five weeks. That happened in October 2008, but did the commission get such a response? Not at all—there was no response. Even as recently as the early part of this year, Mid Staffordshire NHS Foundation Trust was failing to respond to serious conclusions drawn by the Healthcare Commission. That is another reason why it seems to us that the Healthcare Commission was not by any means the last word.
I said that I would also refer to targets. When the Healthcare Commission’s report was published, the Minister said that the issue had nothing to do with targets. Will he accept that, as Dr. Colin-Thomé makes clear in his report:
“A key lesson is that all organisations should be focused on prioritising high quality patient care as judged by outcomes, and whilst process targets are very helpful on the journey, they must not become a distraction from the bigger picture”?
What have we been doing for the past two years? We have been talking endlessly about the importance of focusing on outcomes rather than targets. What have Ministers been doing? They have been talking about the desirability of using targets as the be-all and end-all. Even now, as the new Health Bill is discussed in another place, there is a view that emergency services are measured sufficiently by simple reference to whether the four-hour A and E target is adhered to or not. That ignores the enormous spike when people are discharged from accident and emergency departments after three hours and 59 minutes. Furthermore, the Healthcare Commission report makes it clear that patients were being discharged elsewhere rather than getting the treatment that they needed at the time they needed it in the emergency department.
One of the questions that must be resolved is why staff in the hospital who raised these matters did not get anything done about it, and why others did not blow the whistle when they should have done. I find no evidence in what Dr. Colin-Thomé has reported, or in what
Sir George Alberti has written, to explain that. Dr. Colin-Thomé simply says that it happened—he does not know why. As I am sure that my hon. Friend the Member for Stone (Mr. Cash) will agree, the starting point in finding out what really happened, and why, is to ensure that people at the trust—some of whom, until very recently, felt too intimidated to speak out—feel that they have the protection of giving evidence to a public inquiry under oath, with all the statutory powers that go with that. We have proposals for improving whistleblowing. The Government should have the humility to recognise that nobody contacted Public Concern at Work and nothing was done to bring forward into the public domain the concerns that were clearly held by staff at the trust.
Norman Lamb: The hon. Gentleman raises concerns about a bullying culture. There is also the issue of the duty, or responsibility, of the clinicians themselves. It appears that some clinicians ultimately failed to meet that duty by reporting the serious concerns that they must have had. Does not that also need to be addressed, because someone needs to be held to account in terms of clinical behaviour?
Mr. Lansley: Yes, it does. It may be excessive to expect that even a public inquiry would be able to identify, in all cases, where and to what extent that had happened. However, if a review of case notes gives rise to serious concerns about a significant number of cases, at least a public inquiry would provide a mechanism in the round to consider what that tells us about the clinical governance that was being undertaken and how it may need to be reformed in future.
I want to make a specific point about what has not been achieved by these reviews. For several years, the Government have had the National Patient Safety Agency. One of its principal tasks involves the national reporting and learning system, which should in itself give rise to alerts about the compromise of patient care and errors and inefficiencies. I have failed to see any evidence anywhere in the reviews that the National Patient Safety Agency exists, let alone that it has done anything. If a public inquiry were to look into failings of policy, and needs for the future, that would clearly be one of them.
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