| Previous Section | Index | Home Page |
“and was not asked whether there were concerns about the performance of the Trust in terms of the safety and quality of care... We understand that Monitor asked the Strategic Health Authority for its views; the SHA was aware of our work on mortality outliers and ‘alerts’ by then”,
yet it did not say anything—again, quite extraordinary.
That, of course, raises questions about the chief executive of the SHA, who was Cynthia Bower. I should say that she has been to see me and that I had a very helpful meeting with her; she was very candid. It nevertheless seems to me of fundamental importance that because she was the chief executive of the SHA—one of the performance managers of this hospital—there is a conflict of interest so far as any internal investigation is concerned. That is another clear reason why we must have an independent public inquiry.
The next reason is the role of targets, particularly the four-hour target. The Minister steadfastly sticks to the line that it is all down to just this hospital and the outrageous way its management behaved. When visiting hospitals around the country—I am sure other hon. Members will have noticed the same thing on their visits—I have found that one of the things clinicians say in A and E
departments, and this is a credit to the Government, is that the four-hour target has transformed how A and E and hospitals operate. I accept that it has been transformational: we all know it was unacceptable for people to be left waiting in corridors on trolleys for 10 or 11 hours. The Minister must recognise that there are nevertheless concerns in hospitals up and down the country about how the target is enforced, particularly when it becomes a straitjacket. If the Minister talks to clinicians, as I know he has done, I am sure he will also be aware of concerns expressed about the operation of this target in many hospitals. The Royal College of Nursing has made it very clear that strict adherence to 98 per cent. compliance with the four-hour target has caused real difficulties.
Michael Fabricant: Is the hon. Gentleman aware that a nearby hospital in Westminster provides an example? The system there is that when people enter a room, there is effectively no system until they eventually get to see a nurse for triage—and it is fairly chaotic at times. When I asked why it was like that, I was told that if people were given a number as at a delicatessen counter in a supermarket, the four-hour clock would have to start. What happens, then, is that the patient dripping with blood fails to get to see the triage nurse; meanwhile, the patient who is relatively fit does get to see that nurse when the four-hour clock starts ticking. That is the sort of distortion that occurs.
Norman Lamb: I am grateful for that intervention, as precisely that point was made in the Healthcare Commission report:
“Doctors were moved from treating seriously ill patients to deal with those with more minor ailments, in order to avoid breaching the four-hour waiting time target. Patients were moved to the clinical decision unit to ‘stop the clock’ but were then not properly monitored, since this area was not staffed.”
The hon. Member for Lichfield (Michael Fabricant) has made that point, but the Minister seems blind to the possibility that such concerns might exist elsewhere and that patient care might have been compromised. That is a fundamental reason why a public inquiry needs to explore that issue.
The Healthcare Commission report also included a graph showing a spike just before the four-hour point, with large numbers of patients being discharged as the clocked ticked away towards it. Surely we need to explore whether the same pattern of discharge applies in other hospitals to see whether the same pressures might be applying elsewhere. The Government seem blind even to considering that possibility and so defensive about the four-hour target that they are not prepared even to consider whether any potentially adverse aspects apply to it. The conclusions of the Colin-Thomé report appear also to contradict the Minister with regard to the role of the four-hour target and how it has been implemented.
The next reason there needs to be an independent inquiry is the implications of the scandal for the regulators. The process that this hospital went through to become a foundation trust without anyone stopping the hospital in its tracks to demand improvements before it happened beggars belief. It is extraordinary that it was signed off by the primary care trust, the strategic health authority, the Department of Health, the Secretary of State himself, as I understand it, and the Monitor board.
Did no one notice what was going on in that hospital, right under their noses? It smacks of an appalling tick-box culture whereby, provided those on the ground have ticked the box to say that something is working properly, everybody accepts it and the hospital gets its star rating. That is exactly the same as the culture that applied in Haringey, which gave the local authority three stars at the time when baby P was dying in tragic circumstances. The way in which hospitals achieve secure foundation trust status must surely be further explored.
Mr. Cash: Does the hon. Gentleman accept what I said earlier about the paper trail and the minutes going right back from the current chief executive of the NHS and the chief executive of the Care Quality Commission to Shropshire and Staffordshire strategic health authority and the West Midlands strategic health authority? At the critical time when all these things were happening, the right hon. Member for Leicester, West (Ms Hewitt) was Secretary of State and 17,000 jobs were being cut out of the health service. This is a continuous paper trail, which can be demonstrated.
Norman Lamb: That is the sort of evidence that needs to be properly and fully considered by a public inquiry. A few weeks ago, the press reported on the fact that some 22 hospital trusts have been given foundation trust status despite failings, sometimes of a serious nature, in meeting basic health care standards.
A lot of work on Staffordshire hospital has been done by The Sunday Telegraph, which reported:
“At the point the authorisation was made, the trust was missing government targets to reduce MRSA, had long waits in A&E, and for clot-busting treatment for heart attack victims, the documents from Monitor, the regulator, show.
A further 21 trusts were also given”
“despite concerns about the quality of the care they provided.”
What happened in those cases? They were issued with side letters by Monitor requiring them to take corrective action to remove those concerns, but they still secured foundation trust status. Was that made public? Were the public ever told in all those cases that there were concerns about patient care quality? That is very much not the message that the Government gave when foundation trusts came into being. That status was supposed to be a symbol of absolute quality—quality assurance.
We must bear it in mind that for the chief executives of hospital trusts there is a big financial incentive. They invariably receive substantial pay increases when their hospital becomes a foundation trust. That needs to be looked at in a full public inquiry.
The Conservative spokesman mentioned the handling of complaints. He said that complaints ended up at a range of different destinations, which is surely completely unacceptable. The public must understand exactly what will happen to their complaint if it is not accepted and upheld at trust level.
There are vital lessons that need to be learned from this awful scandal. It is all very easy simply to place all the blame on the local leadership, but there are clearly lessons that the wider NHS and the Department of Health need to learn. It is surely our duty to all patients in the NHS to ensure that those lessons are learned. For that reason, there must be a public inquiry.
Mr. Deputy Speaker (Sir Michael Lord): Order. The clock is moving on, and, given the number of Members seeking to catch my eye, I propose to reduce the limit on speeches to 10 minutes as from now.
8.36 pm
Mr. David Kidney (Stafford) (Lab): As a Labour Member of Parliament I am committed to the NHS, and as Stafford’s Member of Parliament I am committed to a hospital in Stafford, so it broke my heart to read in the Healthcare Commission’s report that patients had been severely, appallingly let down by the NHS and the local hospital.
I support a full, independent public inquiry into every aspect of what went wrong, why, and how it can be put right for the future. I shall vote for an inquiry tonight. Yes, an inquiry will take some time to complete its investigations and deliberations and produce a report, and, yes, it can be distracting for people who have a job to do at the hospital while the investigations are ongoing. However, the work has to be done. One thing we can usefully do is talk about the form and terms of reference of the inquiry. If the Government will not give way on this today, one way in which we can continue the pressure is to start to get ready for an inquiry.
I wish to say a word about my hospital—if I may call it that—and what my public and my patients want today. An inquiry will take some time, but there are things that need urgent attention at Stafford hospital, and I do not want us to lose sight of that urgency because we are also talking about a public inquiry. For example, the Healthcare Commission’s report told us about the severe understaffing on wards and the urgent need for more staff. It told us about missing medical equipment and the urgent need for it to be provided. Six weeks later, Professor Alberti produced his report and said that there were staffing shortages and that more staff urgently needed to be appointed. He said that there was an urgent need to provide some medical equipment that was still missing. Six weeks on, the urgency had not been accepted and implemented. We must not overlook the fact that those things are still urgent today.
I remind the House that the Healthcare Commission produced damning evidence about three aspects of the hospital: accident and emergency, emergency care and some nursing care. However, in the same report it mentioned positive things about the hospital. There were no concerns about elective care, and during the three-year period investigated there was a decline in the number of complaints about out-patient care. There was praise for the acute coronary care unit and the critical care unit. It is important to retain a sense of balance. People going into that hospital had good experiences in some parts of it at some times, just as others had bad, sometimes appallingly bad or fatal experiences. I ask the House to bear that in mind.
When Professor Alberti went in after the Healthcare Commission, he was able to talk about improvements in A and E and say that there had been some improvements in emergency care, although not enough. He mapped the way to continuing that improvement. He said that even when he was there, there were still instances of poor nursing care that needed addressing. He made a warts-and-all assessment, which showed that we still need urgent attention given to some things. It is very important to remember that.
Let us imagine the effects of working at that hospital today, given all the bad publicity that has appeared nationally, and the likelihood that people will complain about anything for fear it will not be spotted if a complaint is not made about it. Let us imagine every story that someone chooses to publicise becoming a headline in the local newspaper. Morale is very low at the hospital. There are fears that even now, as it recruits extra staff, some people will not want to work there because they have seen the publicity.
Into that worrying situation I stepped, with four simple proposals. I wrote to my constituents asking whether they agreed with them. I proposed that those responsible for the management of the hospital on whose failings the Healthcare Commission reported should be replaced, that staffing levels should be corrected and retained, that there should be stronger powers for patients and the public, and that there should be an independent inquiry. So far more than 3,500 constituents have responded, and more than 90 per cent. of them agree with my proposals. I emphasise to the Minister that 3,500 people in the Stafford constituency think that there should be an independent inquiry.
Let me say something about the rebuilding of the trust board. We heard that the chair had resigned just before the publication of the Healthcare Commission’s report. I shall not elaborate on what was said by the hon. Member for South Cambridgeshire (Mr. Lansley) about the treatment of the chief executive. Let me merely say how angry local people are about the fact that “step down” did not mean “resign” at the outset, the fact that he received pay while suspended, and the fact that he is now apparently being allowed to resign with no consequences while still receiving that pay. People are very, very angry about that.
We are recruiting a new chair, a new chief executive and new non-executive directors, and there will be a new board. At present, however, the trust faces the greatest challenges. An interim chair with another job in Sheffield and an interim executive with another job in Chesterfield are managing and leading the hospital. It is still a worrying time, and I ask for Members’ support for the management and staff of the hospital as they try to do all the things that need to be done in the present circumstances.
It is true that the board needs to move from a closed to an open culture, but it has reverted to holding its meetings in public, and at the first of those meetings it reaffirmed its policy on whistleblowing. I showed the whisteblowing policy to Public Concern at Work, which made constructive suggestions for its improvement. The trust has agreed to write to every employee about the policy in this month’s pay packet, confirming that people are free to make their concerns known if they have them. Those are all valuable developments.
It should also be remembered that the board is yet still to present its action plan in response to the report. It is now calling the plan its transformation programme, and I understand that it was agreed with Monitor at the end of last week. There have been some public presentations—for instance, to the overview and scrutiny committee, which has been dealing with the plan—but if we seriously believe that the public and patients should be involved in the trust in the future, we must
accept that the plan will require full public consultation and approval. I am sure we will make certain that that happens.
I should like to say much more about staffing levels, but we are short of time. Although there is no agreed level for wards in this country—or internationally—the Royal College of Nursing has valuable policy guidance, which reminds us that a number of factors must be taken into account. In my view, the dependency levels of patients are an especially important factor; but so, of course, are nursing experience, a skills mix, a settled staff, minimum sickness and absenteeism and less reliance on agency cover, and all those factors affected hospital staff during the time we are discussing.
I agree that the handling of complaints was atrocious, and that we must adopt an “open and learning” culture. That will require constant dialogue between patients, their relatives, the public, and those who work at the hospital. It should not be a big thing to say that something is wrong at the hospital: people should be able to accept that and act on it. I have told Ministers before today that the LINk in Staffordshire is particularly poorly developed. We need to be helped to make it the best of its kind, not one of the weaker of its kind.
Let me now deal with the arguments for an inquiry. We do need an inquiry. The trust pulled the wool over the eyes of the Healthcare Commission for three years. In each of those three years, the commission produced improving assessments of a trust that it later said was so bad. Is the problem self-assessment? Does it constitute a failing of the commission itself that it received more complaints about this trust, in relation to its size, than about any other, and that it produced action plans in response to stage 2 complaints but did not pursue them to establish whether they were implemented? The chairman of that body said there was no need for a public inquiry, but one of the things such an inquiry would look into is the performance of his organisation.
There should be an investigation. The trust pulled the wool over the eyes of Monitor, as we have heard. The big black hole was about clinical care, where Ministers now accept there was a lacuna, but that has now been put right. Even in terms of Monitor’s expert area of governance, management and leadership, the Healthcare Commission report tears the trust apart for secrecy, for as little as possible being reported to the board, and for as little as possible of the board’s conduct being made public. Those issues should be investigated.
For me, the biggest issue is the independence of the case reviews for the relatives of deceased patients, because the trust has organised those reviews—albeit while bringing in outside clinicians who are independent of it. How can people feel trust in that system? Such reviews should be anchored in a public inquiry; and if there is a role to be considered for the coroner, that needs to be looked into as well.
All I want to say in conclusion is that 3,500 of my constituents have said there should be an inquiry, and the local councils—Stafford borough and Cannock Chase district—have resolved that there should an inquiry as well. The Patients Association has a national petition that people are signing, and the RCN supports this, and PACE 2000, an organisation of elderly people in my constituency, also thinks there should be an inquiry. That is a lot of people, and the Minister should listen to them.
8.46 pm
Mr. William Cash (Stone) (Con): This is a debate about freedom of information. It is a tale of cover-ups by two closed cultures: a cover-up by the hospital and its superior organisations, and a cover-up by the Government and their subordinate public organisations. That has resulted in a pincer movement of both death and despair. My constituents and the people representing the interests of the victims and the bereaved demand justice, and they will get justice only if they have a proper inquiry under the Inquiries Act 2005 because that will call for evidence on oath, and have compulsion of witnesses and proper legal protection for whistleblowers, which is not available under the Public Interest Disclosure Act 1998 as it is bypassed. I am saying not that the 1998 Act is bad in itself, but that it does not operate when certain people get to work on it. There are also good people at the hospital who need to be exonerated, and a public inquiry would provide for that.
There is now to be a Select Committee inquiry. That will give us the opportunity to present measured evidence, which we cannot do in 10 minutes tonight. I also ask my party’s shadow Secretary of State to assure us that we would be able to have a public inquiry if and when we get into government next year, because that would be a good opportunity. I strongly suggest that the credibility of the Government is at stake—and I must say that I dismiss with contempt the Minister’s recent trivial speech. Already, two governors have called for a public inquiry of the kind that is required and, as the hon. Member for Stafford (Mr. Kidney) has said, Stafford borough council was unanimous in its demand for one.
I would like to quote from a statement from one of the nurses at this hospital. I want to read it out because it is very important. “X” and “Y” are my terms for two nurses:
“I spoke to X. I explained to her the situation and asked her to relay this information to Y. Whilst she did this she kept me on the phone. I heard her tell Y that I had discovered that several patients had breached. I then heard Y tell X to tell me to lie. X came back on to the phone and told me that Y’s advice to me was to lie. I told her I was not happy to do this and explained that I had informed the clinical site manager of the breaches.”
She went on to make another statement, again at a critical time. She said:
“I have become increasingly frightened in my place of work,”
| Next Section | Index | Home Page |