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“feeling more and more threatened.”
She quotes one of the nurses saying that
“you want to watch being in with her, a lot of people are getting fed up with her and she is going to get what’s coming to her. You want to watch your back and be careful or you’ll go down with her!”
She also refers to “the cumulative effect” and says that
“the net result has led me to feel quite terrified given the present context.”
Then she talks about lying about the breach time and an occasion about which she said:
“This incident led me to feel profoundly shocked that a senior colleague could firstly blatantly lie about a patient’s breach time, and secondly submit documentation, altered by her, in my name thereby knowingly leaving me open to disciplinary action.”
The statement then contains reference to another patient and quotes that involve some effings here and there. Then she says in respect of a particular patient
“I have heard”—
“state that she was going to get rid of him. Most recently following his hospital admission after taking an overdose I was present when she said ‘He should have taken a few more pills and done the job properly.’”
The hon. Member for North Norfolk (Norman Lamb), who spoke for the Liberal Democrats, mentioned racism. The following quotes are mentioned in the statement:
“‘what have you got in that ruck-sack Doctor, is it a bomb?’...‘Him with the turban’ or ‘Her with the yashmak.’...‘Him over there—Osama’s mate’”.
Things continue in the same manner. These allegations clearly have to be properly examined.
I am not using the names of the people involved, for reasons that I shall come to in a minute. The Minister will not deny that he has asked me why, if I have the evidence—for which people were shrieking when I raised the matter when objecting to our being prevented from having an oral statement—“I do not anonymise. I shall tell both him and the House why: when I did anonymise it, in a letter to the Secretary of State relating to a hospital nearby, the next thing I knew, after a considerable pause, was that the consultant in question had been suspended. Only last week, he was summoned for a Kafkaesque trial as if he needed to have a psychiatric assessment. I can tell the House that that consultant and the patient in question are constituents of mine and that consultant had saved the child’s life. I am so furious that I cannot speak about it. This is the way things are carrying on and we hear these platitudes about whistleblowers being protected under the legislation.
The marvellous Public Concern at Work charity has made its criticisms, as the hon. Member for Stafford knows because we have been given the same material. The fact is that the whistleblowing policy in this particular hospital has to be reformed along the lines that we will explain later in the Select Committee—unfortunately, I have not time to go into this tonight.
I am holding a paper written by another consultant, who was suspended at one and a half hours’ notice because he had had the temerity to complain about antibiotic policy—he had been with the hospital for many years. I must be careful, because I do not want to expose others to the kind of treatment that the consultant to whom I have referred has received. He was suspended after such a short a notice period on the issue of antibiotic policy and the non-availability of nurses on consultant ward rounds. This is a national disgrace and the legislation does not protect such people properly. The reality is that the allegations that I am making need to be properly examined by the Select Committee, when we have more time to do the job.
I move on to the question of the manner in which the Government have covered up. I mentioned, much to the Minister’s hilarity, which I thought pathetic, that Ian Kennedy—he wrote the foreword to the Bristol inquiry—subsequently became chairman of the Healthcare Commission, produced the Stafford report and came
up with a different version about the value of public inquiries. That was the point I was making. Ian Kennedy had said:
“A Public Inquiry cannot turn back the clock. It can, however, offer an opportunity to let all those touched by the events, in our case Bristol, be heard and to listen to others.”
He had gone on to talk about the
“public venting of anger, distress and frustration; it provides a public stage on which this can take place.”
I say again that if it is good enough for Bristol, it is good enough for us. He has obviously changed his mind since he became chairman of the Healthcare Commission, and I would like to get all that on the record.
Mr. Lansley: Does my hon. Friend agree that Ian Kennedy—understandably, in the case of Stafford—was defending the Healthcare Commission, not least because when the Healthcare Commission undertook an investigation it would like not to feel that a precedent had been set that meant that it could be second-guessed by a call for a public inquiry? Does my hon. Friend accept that I do not see this necessarily as setting a precedent? We did not ask for an inquiry after Maidstone and Tunbridge Wells, nor would we set out to do so in other cases. The evidence in this case seems to point to such a wide range of unresolved issues that it demands that we go down that path.
Mr. Cash: I absolutely agree with my hon. Friend, and so does the Royal College of Nursing, which said that the focus on achieving financial targets at Mid Staffordshire was at the expense of appropriate and safe staffing levels and talked about cuts in the number of nurses.
As I said, the real question is also one of a Government cover-up. It has caused me a lot of difficulty to get some of these minutes, but there is no doubt that the minutes of the various strategic health authorities—I have them all, so I shall be able to go into them in due course, although not tonight—show a direct paper trail from the decisions that were made when David Nicholson was chairman of certain of these authorities that continued all the way through under the aegis of the right hon. Member for Leicester, West (Ms Hewitt) and also under that of the present Secretary of State. They are all about targets, finance and matters of that kind. Also involved is Mr. Bill Moyes. There is a conflict of interest for the university of Birmingham, which was commissioned by the West Midlands strategic health authority, and a conflict of interest for Mrs. Cynthia Bower, who is now chief executive of the Care Quality Commission.
The problem that troubles me is the continual conflicts of interest. For example, the university of Birmingham study was funded by the SHA, which set up the steering committee to guide the study. The people who were on the study that led to the analysis of the mortality rates in Mid Staffordshire included the medical director of the SHA and people from the trusts, including the information manager of the Mid Staffordshire NHS Foundation Trust. That is a blatant example of conflict of interest.
In conclusion, although there is much more information that I would like to get out, I shall simply say that we should consider the opening remarks and the constant references to finance, finance, finance in the Mid Staffordshire challenge-to-challenge board meeting. Bill
Moyes, now of Monitor, who gave this trust status, said in the vital board-to-board meeting on 5 December 2007 that
“questioning would concentrate on the financial viability and governance of the Trust.”
8.58 pm
Dr. Tony Wright (Cannock Chase) (Lab): It might not be entirely evident from the previous contribution, but we Staffordshire MPs are a rather happy and consensual bunch. We meet regularly on a cross-party basis, and that is certainly unusual—it might even be unique in the House. We have been doing so for many years. When we met just last week, we obviously discussed this topic, and we came up with what we thought was a positive idea, which was that we should get all the various people involved in the case—the hospital trust, the primary care trust, the strategic health authority and the regulator—into a room to ensure that they were making things better. The emphasis today—quite rightly, as it is the focus of the motion—has been on settling the issues with the past. The other, and in some ways more pressing, side of the argument is the need to settle the issues with the future.
What the people we represent want is an absolute assurance that the problems in Stafford hospital are being sorted out, and that the kind of experiences that the Healthcare Commission report documented are not being repeated. We know that in some respects, at least, they are still being repeated. In some respects, however, they are not: as far as we can tell, the particular acute problems in the accident and emergency department have been resolved by increased staffing, better organisation and so on. However, the Alberti report tells us that there are still problems on the medical wards. The kind of problems that people come to my hon. Friend the Member for Stafford (Mr. Kidney) or to me with are basic care issues on the wards. Indeed, this weekend I was dealing with a problem, relating to exactly those issues, that is happening now.
Alberti tells us that there is still a real staffing issue on those wards. The implication is that the care is not good enough. It is to that that we must urgently turn our attention. As my hon. Friend the Member for Stafford said, Alberti also tells us that there are issues with staff not wanting to work in the hospital. “Who wants to work in Stafford hospital?”—so it goes inside the system. The hospital is desperately trying to get agency nurses in, because it cannot recruit normally. Real reputational damage has been done to the hospital, and there has been a real loss of public confidence locally. Those are all matters that need to be attended to.
As for the reports published so far, I have found them useful. It is difficult for people to say, in a general sense, that we do not know what happened at Stafford. I am afraid that we do know what happened at Stafford. It is difficult to say that we do not know why it happened; having read those reports, I think I do know why it happened. It is difficult to say that we do not know what to do, because we do know what to do to remedy the problems identified. I agree that there are outstanding issues; in a sense, there always will be. There are questions to which we still need answers, and some of them have been raised today. However, on the essence of the
matter, I do not think that anybody can claim that we do not know what happened, why it happened, or what we need to do.
For me, the devastating part of the reports—devastating because it confirms the impression that I formed of the hospital from cases I had dealt with—was that there was a complete inattention to patients. There was a preoccupation with process. All the reports that have been produced say that. They all identify that as the key issue. That raises many questions about how on earth a hospital could have taken its eye off the ball so comprehensively as far as patients were concerned. How could it not have understood that the quality of patient care is central to all that it does? The reports talk about the problem of culture inside the institution. “Problem of culture” means not understanding that patient care is central. It means not having set a standard of patient care, around which everything is organised. I am afraid that what the reports tell us about the failure to use complaints intelligently is simply part of that. I speak as someone who has taken a perverse, obsessive interest in complaints over many years.
We all know, if we are honest, that we never got the system of complaints inside the health service right. I remember sitting on inquiries into complaints in the health service under the previous Government, when it was widely recognised that we had a problem. There have been endless inquiries since then into how we can improve complaints systems. We have set up different systems and tried them out; they have failed, and we have tried new ones.
I remember listening a few years ago to the permanent secretary of the Department of Health, I think it was, describing how he wanted every patient who came into an NHS hospital to be given what he called a “three Cs” form. The three Cs were comment, complaint and congratulation. I thought that that was sensible, but when I asked him whether the forms would be universally available in every hospital, he said no; they would simply be available if people wanted to use them. I think we ought systematically to make sure that every in-patient in every hospital in the country is asked for their comments, complaints and congratulations. Having done that, however, we must ensure that in every institution we learn in a systematic and serious way. It is no good simply getting people to tell us things if we do not learn from what they have told us and act on it. There is no reason at all not to do so. Lord Darzi’s intervention is extremely valuable in reminding us of something of which we should not need to be reminded: that the quality of patient experience is absolutely central to what the health service ought to be about.
Mr. Cash: I thank the hon. Gentleman for giving way in the interests of comity in Staffordshire. Does he agree that there is a serious problem with targets and money? Although he may not have seen the report, in the board-to-board meeting on 5 December, which was decisive for the purposes of granting foundation trust status and was chaired by Mr. Moyes, nine out of 46 questions were about matters other than money—some 35 questions were about money, targets and such things. We must learn from that, as that was where the problem lay.
Dr. Wright:
My view is that that was overwhelmingly a particular problem in that institution. Indeed, on the
day on which the Healthcare Commission report was published, its chairman, Sir Ian Kennedy, to whom reference has been made, went on the radio to say that the NHS was steadily improving. I believe that that is the case, and I speak as someone who uses the NHS heavily. Indeed, I was in hospital this morning being attended to. My experience over the past 10 years is that it is steadily improving. However, there is no question of its improving over the years in Stafford, because the trust did not understand the centrality of patient care.
I want to spend the last couple of minutes on the inquiry. I am not going to vote against the motion, but I am not going to vote for it, either. There is a real problem with capturing the advantages of a further inquiry, given some pretty demonstrable disadvantages. The advantages are clear: there are questions still to be answered, and there are certainly people on the ground who have been personally affected and whose questions remain unresolved. However, we must not think that a further inquiry does not involve costs. If we are to achieve a relentless focus on improvement, I am not sure that that will be aided by a relentless focus on the past. I want assurances that we can have a further inquiry to tell us things we do not know, but without it carrying the great disadvantage of our taking our eye off the ball and failing to do the things locally that we have to do.
Five years ago, the Committee that I have the privilege of chairing produced a big report on the whole question of inquiries. The Inquiries Act 2005 was being introduced, and the Government gave evidence to us. We had asked them in what circumstances they would hold an inquiry, and they said:
“There is no standard blueprint for the type of circumstances in which an inquiry might be needed. Matters triggering inquiries are by their nature difficult to foresee.”
“A common theme tends to be that the subject matter of the inquiry has exposed some possible failing in systems or services, and so has shaken public confidence in these systems or services either locally or nationally”.
On those grounds, there is no question but that Stafford fits: it has shaken public confidence, and the problem is of sufficient severity. We tried to do a little better—I do not have much time, so I shall abbreviate my remarks—by producing a checklist of questions that were sensible to ask when the issue of an inquiry arose. As MPs, we ask for inquiries like children ask for sweets—it is what we do—so there is a discipline in having to ask such questions. I do not have time to recite them all.
Mr. Lansley: Given the point that the hon. Gentleman made about diversion, does he not accept that nurses working at Staffordshire general hospital, as reported to me by the general secretary of the Royal College of Nursing, wanted a public inquiry?
Dr. Wright: Indeed, and I want an inquiry that tells us some of the things we do not know, but if we are being fair, those people urging a further inquiry have also to be fair and recognise that there are potential risks and dangers in having one. We all want to settle accounts with the past, but we also want to make sure that urgent improvements are made now.
I end by quoting from Professor Alberti at the end of this report. With reference to Stafford he says:
“The Trust has the potential to become a model small to medium-sized hospital of the future with care delivered promptly and appropriately both in the community and in the hospital—and with poor patient experience a dim and distant memory.”
In talking about inquiries, the question is whether we can capture some of the advantages of holding a further inquiry while offsetting the very evident possible disadvantages in pursuit of that objective. That is the conversation I intend to have continually with the Government. The Secretary of State has said several times to several of us that he would be happy to have a further inquiry if he thought it would do any good. It is our job to explain to him that it might do some good without doing some harm.
9.11 pm
Michael Fabricant (Lichfield) (Con): The hon. Member for Cannock Chase (Dr. Wright), whom it is my privilege to follow, spoke about the criteria that the Government believe in for a public inquiry. One of the criteria he mentioned was that of systemic failure. The problem that faces us in Staffordshire is one of systemic failure, but it is systemic failure that exists in other hospitals too.
Before I go any further, I echo the opening words of my friend the hon. Member for Stafford (Mr. Kidney) by saying that, as a Conservative MP, I support the national health service, and as a Conservative MP, I support the workers in the NHS, particularly the workers in Stafford hospital, who at present work under such difficult conditions and who, I am sure, will look at the contents of this debate.
I said that there have been systemic failures. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, mentioned the problem of whistleblowers. At a previous Health questions I said to the Secretary of State for Health that there was another example provided by two people who work in my constituency—I did not give their names because they are terrified that if their names were known, they would lose their job. They work at another hospital in the west midlands and showed me photographs that show disgraceful and unhygienic conditions in that hospital, but they would not leave the evidence with me, which left me in a paralysed situation because I could not do anything without the evidence.
At the time, the Secretary of State told me that he was amazed that despite the protections that exist for whistleblowers, such huge fear still exists. Once again, the Secretary of State, who, I have no doubt, is a good man and has the best interests of the national health service at heart, said that he was “amazed” that whistleblowers did not speak out at Stafford hospital. As my constituents said to me, with nurses, doctors and even consultants being made redundant, would they be next? That is the issue that faces all those who work at Stafford hospital or other hospitals that may not have such acute problems but nevertheless require the shining light of publicity, or at least exposure.
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