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I hope that, in the course of the past few minutes, I have made it clear that the questions about why Stafford hospital failed its patients in emergency services and admissions, as identified in the Healthcare Commission report, have not been answered, and why a public inquiry is therefore needed. The reports thus far have not given the public in Staffordshire a voice, and they have not provided a public opportunity, with protection, for evidence to be taken. The reports were not independent, and they have failed to investigate the direct role of the Department of Health and its policies. Until recently, both the authors were civil servants in the Department of Health: they are not independent, and we should not see them as such. Neither report contained critical scrutiny of the impact of targets. There was no critical examination of the role of the chief executives of the strategic health authorities over the period in question. There was no discussion of the roles of the national reporting and learning system or of the National Patient
Safety Agency. There was no discussion of how the complaints processes have worked or how patient engagement has worked, and no substantive proposals about how they can be reformed in future, as they clearly must be. Instead of robust criticism, all we have is a bureaucratic process. Dr. Colin-Thomé’s report, in particular, suggests that the things that the Government were already planning to do, such as practice-based commissioning, world-class commissioning and LINks, will somehow solve everything. There is no evidence that that will happen—far from it. Indeed, some initiatives, such as practice-based commissioning and LINks, are stalling rather than making the progress that they should.
Because of all that, the reports do not shed light on why those in the hospital and elsewhere failed to stop the tragic events that have killed, or caused avoidable deaths among perhaps hundreds of patients, with all the distress that that has meant for their families. I again pay tribute to Julie Bailey and all her colleagues at the Cure the NHS campaign, who persisted when the situation was very difficult and it took courage to do so in the face of a bureaucracy that was determined that they would not expose what was happening at Stafford hospital. They want an inquiry now, and say that only when we know why and how this happened will the commitment to say “Never again” truly be credible. Ministers have been to see them and have promised to think again, but I do not see the evidence that they have done so. It is therefore incumbent on Parliament to require them to think again, and I commend the motion to the House.
Mr. Deputy Speaker: Order. Before I call the Minister of State, I should remind the House, because it has not been stated on the Annunciator for other reasons, that there is a 15-minute limit on Back-Bench speeches. After the end of the Front-Bench speeches, that might have to be adjusted in a downward direction.
7.46 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes the independent report by the Healthcare Commission which identified severe failings at the Mid Staffordshire NHS Foundation Trust and the follow-up reports by the National Clinical Director for Emergency Care and the National Clinical Director for Primary Care which state that Stafford Hospital’s accident and emergency department is now safe but that further improvements must be made at the Trust and lessons learnt by the whole NHS; further notes that the hospital has offered independent reviews of clinical records to all concerned; agrees that at the present time it would not be appropriate to establish an independent public inquiry; further agrees that management and staff at the hospital must remain focused on delivering high quality patient care; and further agrees that an independent public inquiry could add undue delay to implementing the recommendations of the above reports and therefore to the hospital delivering high quality and safe services for the local community .”
I am grateful for the shadow Health Secretary’s understanding of the fact that my right hon. Friend the Secretary of State cannot be with us this evening because of the assembly of the World Health Organisation.
On 17 March 2009, the Healthcare Commission, then the independent health regulator, published its report into the failings in emergency care at Mid
Staffordshire NHS Foundation Trust between 2005 and mid-2008. It was a catalogue of appalling management and failures at every level, for which the Secretary of State apologised unreservedly on behalf of the Government and the NHS in his statement to the House the next day.
The Government immediately announced a range of measures, including two swift reviews of the circumstances at Stafford hospital, to be led by Professor Sir George Alberti, the national clinical director for emergency care, and Dr. David Colin-Thomé, the national clinical director for primary care. Professor Alberti looked into the hospital’s current procedures for emergency admissions and treatment, and its progress against the recommendations in the Healthcare Commission’s report, while Dr. Colin-Thomé looked into the circumstances surrounding the Mid Staffordshire NHS Foundation Trust prior to the Healthcare Commission’s investigation to learn lessons about how the primary care trust and strategic health authority, within the commissioning and performance management systems that they operated, had failed to expose what was happening at the hospital. Copies of those reports were placed in the Library on 30 April, as was the Government’s response.
I heard what the hon. Gentleman said about the lack of an oral statement. He will know that providing an oral statement is not in the gift of an individual Secretary of State. The Secretary of State has gone out of his way to keep the House informed, but it is up to the business managers. The hon. Gentleman may also recall that on that day Members were discussing MPs’ expenses at some length. I personally would have very much welcomed the opportunity for an oral statement to be made, but it was not agreed to by the business managers.
Mr. Cash: The Minister knows very well that I had a personal conversation with the Secretary of State where he clearly understood that an oral statement was to be given. Furthermore, just before business questions a week last Thursday, I received a letter from the Leader of the House saying, in effect, that she apologised for the fact that an oral statement had not been given because the matter had already been dealt with by a ministerial written statement. The Minister is being disingenuous, to put it mildly.
Mr. Bradshaw: The facts as the hon. Gentleman states them are not correct. The Secretary of State wanted to deliver an oral statement, as he made absolutely clear when he made the original oral statement. The hon. Gentleman has been long enough in this House to know that oral statements are not in the gift of an individual Secretary of State.
Mr. Bradshaw: I will not give way again now. I will do so later to the hon. Gentleman, who has had much opportunity to raise the issue in the House, of which he has not always taken advantage.
Mr. David Kidney (Stafford) (Lab): I would like to move on to the big issue of an inquiry. I want to discuss some elements of the amendment, which states that there should not be an inquiry at this time. Is my hon. Friend willing to start talking to those with an interest—me, other Staffordshire Members of Parliament, Opposition parties—about the form and terms of reference of an inquiry in the near future?
Mr. Bradshaw: As my hon. Friend knows from the many discussions that the Secretary of State and I have held with him, we are always open and willing to discuss any ideas that he has, but I shall address the specific matter of a public inquiry at some length later.
The Government accepted all the recommendations of both reports and have begun to implement them in full. In summary, the reports found that, first, significant improvements had already been made at Stafford hospital. Services in accident and emergency were now safe, but there was an urgent need to make further improvements to other services and to rebuild local confidence in the trust. Secondly, in the past, patients’ views were not taken seriously enough and were too easily dismissed. Thirdly, there was a lamentable failure of clinical leadership in the trust and the wider health community. Fourthly, the commissioners of local health services were not sufficiently aware of the poor-quality care in the hospital or active in addressing it. Fifthly, all parts of the system should have worked together better in the interests of patients.
Some have attempted to suggest that what happened at Stafford hospital is typical of the NHS as a whole, or was a result of targets or some other national policy. It is important to recognise, not least because of the fantastic job that NHS staff do in hospitals throughout the country, that the Healthcare Commission and the two subsequent reports found that what happened at Stafford hospital was the result of catastrophic local failure. Every NHS nurse, doctor and manager in the country to whom I have spoken is as horrified by events there as we all are.
The onus must, therefore, be first and foremost on Mid Staffordshire NHS Foundation Trust, together with its local partners and South Staffordshire primary care trust, to address the recommendations relevant to them in the reports, make further improvements in the quality of care and rebuild local confidence.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): Does the Minister have confidence in the procedure that Monitor adopted to secure foundation status for Stafford hospital? What worried me when Bill Moyes appeared before the Health Committee was that he talked about looking at press reports in future to get intelligence about hospitals. I would have hoped that the investigation would be much more robust. I am concerned about what that means for the process that University hospital of North Staffordshire may undergo soon. It, too, wants foundation status.
Mr. Bradshaw: As my hon. Friend knows, Monitor has changed and made more robust its process for assessing candidates for foundation trust status. Even at the time, it considered quality of care. As she knows, the Healthcare Commission’s announcement of a formal investigation came after foundation trust status had been granted to Stafford hospital. However, I will raise her concerns with Bill Moyes on her behalf, and I trust that she will do so about University hospital of North Staffordshire.
We all understand the need for the relatives of patients who died at Stafford hospital to know whether there is any suggestion that death was attributable to the poor care described in the Healthcare Commission’s report. The primary care trust has a widely publicised confidential
helpline, on which concerned relatives can request a thorough and independent review of the clinical records of the patient in question.
The coroner in South Staffordshire, who was also mentioned in the Healthcare Commission report, has said that he will consider any requests for an inquest from the relatives of patients who died at Stafford hospital.
Norman Lamb: It is encouraging to hear about the coroner’s change of heart, but is not a change to legislation required to ensure that, in future, there is no refusal to co-operate with an inquiry, as happened in this case?
Mr. Bradshaw: The coroner disputes that allegation—I simply point that out to the hon. Gentleman. The coroner does not accept that version of events. The hon. Gentleman knows that a measure is currently being considered in Parliament, which addresses some of the issues that he raises.
The reports of both Dr. David Colin-Thomé and the Healthcare Commission were highly critical of the closed culture that operated at Stafford hospital. All NHS organisations must ensure that they operate in accordance with the current guidance, which promotes openness, transparency and accountability to their local populations. That includes boards holding meetings in public. The new board of the hospital now holds its quarterly meetings in public.
It is clear from the reports that complaints were not tackled satisfactorily at Mid Staffordshire NHS Foundation Trust. The high number of upheld complaints was one of the things that first worried the Healthcare Commission. As of 1 April this year, we have reformed and strengthened the NHS complaints system. Hospitals need to do better at resolving complaints locally. The independent parliamentary and health service ombudsman remains the ultimate arbiter on patient complaints. Information on complaints is already available from the Care Quality Commission, the ombudsman and the NHS information centre— [Interruption.] The hon. Member for South Cambridgeshire (Mr. Lansley) is chatting. When he talked about complaints, he referred only to the content of the reports; he did not mention the series of actions that the Government announced to address them at the same time as the reports were published. I am explaining that to him now, if he has the courtesy to listen.
We are discussing with the health ombudsman publishing the number of complaints from each trust referred to and upheld by her. All that information will be placed on the NHS Choices website, allowing easier comparisons between hospitals.
Joan Walley (Stoke-on-Trent, North) (Lab): I welcome my hon. Friend’s comments about examining local improvements that need to be made. I have read the two reports and I welcome the fact that, in three months, the PCT, Monitor and the Healthcare Commission will examine the way in which local services have improved. Does he share my concern that, although that covers examining local improvements, in the fullness of time we need a full inquiry to consider systemic problems on a national basis so that we can all learn from a tragic incident that involves many people? We need to ensure that we learn from that, not only in one local area but throughout the country.
Mr. Bradshaw: I have sympathy with my hon. Friend’s comments about the importance of going back and ensuring that Stafford hospital has acted on the recommendations of the Healthcare Commission report and the other two reports. However, she knows that the independent regulator’s report and the others stated that they were satisfied that the problems in Stafford hospital were not systemic in the NHS as a whole. To claim that would be a great mistake and do a great disservice to NHS staff throughout the country—the vast majority of hospitals manage to hit the A and E four-hour waiting target and deliver high-quality and safe care to their patients every day. We have ascertained the lessons to be learned for the rest of the service from the Healthcare Commission report and the other reports, and they are already being implemented. However, I do not believe that the Opposition and some other hon. Members are calling for an inquiry into that. They want an inquiry into the specific circumstances at Stafford hospital and I shall shortly cover why that would not necessarily be sensible at this stage.
Mr. Gummer: Will the Minister help me and explain to my constituents how we can believe in the new attitude to complaints when my people have been told that the minimum time for a journey from their home to emergency heart operations is 160 minutes? My constituents complained before the changes were made, yet it has been announced that there is no need for public consultation on the changes. The Minister must accept that we need a report on the subject that we are considering to raise the bigger problem throughout the country that complaints are not being heeded—either after changes are made or before they are implemented. Strategic health authorities currently issue a diktat. He must understand that complaints must be listened to.
Mr. Deputy Speaker: Order. The interventions are getting a little long and we have a limited time for hon. Members who wish to speak on the subject from the Back Benches.
Mr. Bradshaw: I shall take your advice, Mr. Deputy Speaker, and be a little more conservative in my tolerance of interventions.
The right hon. Member for Suffolk, Coastal (Mr. Gummer) confuses complaints about individual poor care with service changes. I think that he referred to a proposed service change by his local hospital or PCT. I am sure that he knows that there is a robust and formal consultation process for such a change. One of the most effective things he can do is persuade his local—probably Conservative—councillors, who dominate the overview and scrutiny committee in his area—
Mr. Bradshaw: Is not Suffolk county council a Conservative authority? The councillors can raise concerns and refer a major service change, with which the right hon. Gentleman is unhappy, to an independent national panel.
Another thing that alerted the Healthcare Commission to potential problems at Stafford hospital was its very poor performance in the annual NHS staff survey. The question of whether staff would be happy to be treated in the hospital where they worked was dropped by the Healthcare Commission in 2007 because of concerns that its wording could lead to distorted results for some providers.
Mr. Bradshaw: The hon. Gentleman, again from a sedentary position, says, “Rubbish.” The Healthcare Commission—the independent regulator—made that decision because of the danger that if, for example, those working in a psychiatric hospital were asked whether they would like to be treated in their hospital, a lot would obviously say no. We have agreed with the Care Quality Commission to reintroduce the question asking staff how they rate the quality of care in their hospitals, albeit avoiding the problematic wording of the question contained in the earlier survey.
Mr. Lansley: The hon. Gentleman said the decision was taken by the independent health regulator, but will he confirm that the decision to drop the question—not the decision to reform it—was made in direct consultation with his Department?
Mr. Bradshaw: No, the survey belongs to the independent regulator. The regulator consulted the Department and, for the reasons that I have explained to the hon. Gentleman, we accepted its concern that the wording could distort the responses of those working in psychiatric hospitals, in mental health and so on.
The hon. Gentleman also talked about whistleblowing. Although the board at Mid Staffordshire did not listen to the concerns of patients or staff, we share his surprise that more professionals in the trust did not put their concerns on the record. The NHS exists to meet the needs of patients. Individual members of staff have a right—indeed, a duty—to raise any concerns that they may have about the quality of patient care with their employer. It is important to remind all staff who work in the NHS and their managers that whistleblowers have full protection under the Public Interest Disclosure Act 1998. Furthermore, the new NHS constitution includes an explicit right for staff who report wrongdoing to be protected.
Let me deal with the central issue of the Opposition motion, which is the call for a public inquiry. Public inquiries can be an important mechanism to establish independently the cause of a problem or disaster. I can understand that there are many who consider that a public inquiry into the events at Mid Staffordshire is both appropriate and necessary. A number of people have recalled the Bristol heart babies inquiry. In our view the critical difference is that that inquiry was initiated when, under the previous Conservative Government, there was no independent watchdog or regulator for the NHS.
The whole point of establishing the Commission for Health Improvement in 2000 and the subsequent regulators since was to provide the public with the confidence that any concerns that they might have about NHS care in their areas would be properly and independently investigated. I have not heard any criticism of the Healthcare Commission’s investigation or any suggestions that it did not get to the bottom of what went wrong at Stafford hospital. Given that, as well as the two subsequent inquiries and the action flowing from them, the Government remain unconvinced at this time that a public inquiry would add anything to our understanding of what went wrong or of what needs to be done to prevent such terrible events from happening again.
Norman Lamb: Will the Minister give way?
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