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The report came out a few months ago and spoke of systemic weaknesses that have existed over the past three or four years. However, I spent a day with a paramedic crew from the old Staffordshire ambulance service, before it became a part of the West Midlands ambulance service. The crew said to me in 2000, “Mr. Fabricant, if, God forbid, anything happens to you or your dearest, don’t send them to Stafford. If you have to go to A and E, go to Burton hospital, because the survival rate is far greater there.” I believe that the problem has existed for many years and is not just a recent occurrence.
We have heard about the evidence from nurses. One nurse provided senior managers with details of her concerns in November 2007, but they were ignored. Her report talked about doctors and nurses being ordered to discharge people who were critically ill and, as we have already heard from my hon. Friend the Member for Stone (Mr. Cash), to lie about how long others were waiting.
The nurse documented cases, including that of an elderly patient who died the day after being sent home against her doctor’s wishes. The lady concerned, who suffered from a bowel condition, had been taken to A and E suffering from acute abdominal pain, and anyone who has been to medical school for just a year and a half, let alone longer, will know that acute abdominal pain needs to be examined very seriously. It turned out that she had a perforated bowel, but she was sent home because that was the ethos at Stafford general hospital. The nurse said:
“I will never forgive the moment when the patient clasped my hand and said ‘Am I going to die?’ I can’t say that she would definitely have been saved if she had been given the right care, but at the very least she should have been given some comfort and dignity.”
Despite the disadvantages that the Minister and the hon. Member for Cannock Chase have pointed out, I passionately believe that we still need a public inquiry, not to look to the past, but to provide lessons so that we can avoid the situation in the future at Stafford general hospital and stop the instances that I discussed a few moments ago which prevent whistleblowers in other hospitals from making their views known. A public inquiry is important for our constituents, and I commend the hon. Member for Stafford for having the courage of his convictions and saying that he will vote tonight for an inquiry. His constituents, like mine and others in Staffordshire, all want to feel that justice will not only be done, but be seen to be done, and that there will be lessons learned and additional protections not only at Stafford general hospital but at hospitals in other parts of the country.
The Under-Secretary of State for Health needs to answer some questions, and I should be grateful if she addressed them in her winding-up speech. First, does she think it right that the former chairman of the West Midlands strategic health authority, Cynthia Bower, is now in charge of the Care Quality Commission, the actual body that is responsible for monitoring the progress of Mid Staffordshire NHS Foundation Trust? Surely that is a conflict of interest. If there is not a public inquiry, what action can the Minister take to restore faith in Stafford general hospital among the residents not only of Stafford but of other parts of Staffordshire?
How will we recruit nurses? We have already heard that there is a recruitment problem, because Stafford general is now branded a hospital that we would not wish it to be. One has only to read the comments in Staffordshire newspapers, such as the Stoke Sentinel, the Staffordshire Newsletter, and the Express and Star, to know the very real concerns that people continue to have about health care in the area.
What progress is being made towards a coherent five-year plan for the trust, as recommended by the Alberti report? Still we hear that medical care on the wards is not as it should be. What progress is being made towards recruiting experienced surgeons for night shifts at the hospital? That is still a real problem for a hospital with an accident and emergency department. Finally, can the Minister give assurances that, at hospitals nationwide and not just at Stafford, patients are not simply being dumped outside accident and emergency wards so that the four-hour waiting time targets can be hit?
As I mentioned earlier in an intervention, such things happen not only at Stafford hospital, but here in Westminster—I have seen it for myself. Yes, targets can be good; I am not saying that we should have no targets at all. But not to accept that targets can endanger and distort clinical care is to live in a dangerous fantasy that puts the lives of all our constituents at risk.
9.21 pm
Dr. Richard Taylor (Wyre Forest) (Ind): I commend the hon. Member for Stone (Mr. Cash) for his powerful comments. He has been attacked because he did not come to my debate on whistleblowing; it was said that he had not taken every opportunity to participate in debates. I should defend him. As that debate was so short, I said that I would not take any interventions and I encouraged him not to come.
Having got that off my chest, I turn to the Minister’s contribution. He said that he might change his mind. The whole point of debates in this place is to give people a chance to change their minds. I have changed the mind of only one MP during my whole career here—but as I have done it once, I have every hope of doing it again. My presence here shows that the concerns go wider than Stafford. The hon. Member for Cannock Chase (Dr. Wright) implied that we know why it all happened, but I do not think that we know enough. We have to find out more, so that the same does not happen anywhere else.
I have looked through the Healthcare Commission report in some detail because I am very bothered about why there were no whistleblowers. The Minister himself stated that staff did not put their concerns on record, and the hon. Member for North Norfolk (Norman Lamb) also implied that. Actually, what they say is not correct; the report shows that concerns were raised. I shall pick out some bits of it to show that. Page 37 states that
“Many clinical staff told us of their concerns about the quality of care at the trust and gave specific examples.”
Further on, the report states:
“In September 2006, a paper to the hospital management board highlighted how the one in two on-call rota, with the two consultants taking turns to cover, was not tenable.”
Page 45 refers to the same paper’s reference to the inadequate level of middle-grade staffing. Page 46
mentions that the regional postgraduate dean drew attention to problems of the training and supervision of middle-grade doctors.
Page 47 contains a long paragraph, which I am afraid I am going to quote:
“In April 2005, the medical division identified a risk that there would be too few staff to support the service due to failing to replace staff who terminated their employment. This was recorded on the risk register, but no review date was provided. In July 2005, it was noted that future demands of the service may not be met due to insufficient levels of staff in the department. From these entries, it is evident that staffing levels were considered to be inadequate as far back as 2005.”
Page 47 also refers to a review by the Heart of England NHS Foundation Trust that was critical of the level of nursing supervision. Page 62 describes reconfiguration of the medical wards in 2006, which led to changes in the skills mix of the nursing staff that were unacceptable to many consultants.
Mr. Cash: Does the hon. Gentleman accept that the details of the Healthcare Commission report clearly demonstrate that the board was spending too much time on finance and matters of that kind? As I demonstrated from the minutes, this goes right the way back to the early decisions that were taken by the strategic health authorities, which were based on targets that are part and parcel of the national health system as a whole, as run by the current chief executive of the NHS.
Dr. Taylor: I thank the hon. Gentleman for that intervention. I will come to exactly that point a little later, because there is a quote about it in the report.
Another important part of the report, on page 63, concerns high levels of staff sickness and complaints to the commission that had not been taken up. On page 93, there is an absolutely vital table that summarises some of the findings about the trust’s approach to levels of nursing staff. It says:
“In 2002, the review of clinical governance by the Commission for Health Improvement pointed out that the number of nurses was low compared with other similar hospitals.”
“In 2005, the trust had more wards with below the national average number of nurses than wards with above the average, by almost two to one.”
Anybody who reads page 93 can pick up on several similar points.
Why did all the long-standing concerns that had been expressed never get through? We have to find out where the blockage was. Was it between the working doctors and nurses and their clinical directors or nurse managers, or between the clinical directors or nurse managers and the medical director and the director of nursing? Was it held up above that level, by the chief executive preventing it from getting to the board? There are some clues about why senior staff perhaps did not make more effort to take matters wider. Page 101 of the report says:
“Staff, including senior staff, had little confidence that the trust learned from incidents.”
On page 106, the Healthcare Commission says:
“We did not gain an impression from staff that the trust had had an open culture in which concerns could be raised, were welcomed and resolved. We have noted above that several consultants considered that the trust did not welcome criticism or concerns.”
On page 108, we see the point raised by the hon. Member for Stone:
“The minutes of the board show that finance and achieving foundation trust status were given high priority. There was little recorded discussion about quality of care.”
There are still questions about where these complaints were held up. Why were whistleblowers not going higher to the Royal College of Nursing or direct to the strategic health authority? I hope that we will ask those questions at the Health Committee meeting dedicated to this problem.
The Health Secretary has made some useful suggestions for the future, but I am currently much more interested in the past. That is why I believe that an independent inquiry is essential and should not be deferred. We want the people who have got us into this state, not those who are trying to get us out of it, to appear before an inquiry. We know that many new young consultants have been appointed who have nothing to do with what has happened and that there are new interim executives. Surely we could separate the people responsible for what has happened from those who are interested in the future. I strongly support the plea for an independent inquiry to satisfy staff—and exonerate those who had nothing to do with it—relatives and patients. At the same time, it is crucial to continue to make improvements for the future. However, I believe that different people are making the improvements from those who caused the problems in the past.
9.31 pm
Mr. Robert Syms (Poole) (Con): As a member of the Select Committee on Health, I intend to make only a brief contribution. Like the hon. Member for Wyre Forest (Dr. Taylor), who is also a member, I look forward to taking evidence and listening to what people have to say.
I thank my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). The subject is unusual for Opposition day debates, but the issues that it raises are important for us all and the NHS generally. At least, we have put pressure on the Government and asked them more questions about outcomes and what is happening.
Four hundred people may have died as a result of what happened. If a jumbo jet had fallen out of the sky or been blown up, or a major train crash had occurred, there would be a public inquiry. I understand the Minister’s comments about the length of time we have spent and so on, but we are considering individual and family tragedies, about which people want their say. They want to listen to other people’s evidence. That is important for not only the grieving process, but the community around the hospital, who look to it to care for their family and friends, and feel let down.
We also need a public inquiry because staff have been put under tremendous pressure in the hospital. We have heard many examples of people who have been forced to input data into computers and use all sorts of methods to deal with the target regime. I appreciate that staffing levels have improved, but when a hospital gets a bad name, it is difficult to get people of high quality and calibre back into that hospital to turn things around.
My hon. Friends and Labour Members who are present, for whom I have great respect, have called for a public inquiry and there is a general view that we need to examine the matter more deeply and reflect on the issues that have been raised.
There are several concerns. I broadly welcome foundation trusts, but, as has been said, I was amazed that we ended up with a foundation trust, when, apart from the Secretary of State’s recommendation, the evidence was based on various tiers and organisations in the NHS, which were all thought to be robust. That turned out not to be the case when foundation trust status was granted in 2008.
I welcome the Minister’s comments at the beginning of the debate about the steps that have been taken to improve the service. The Care Quality Commission, the PCT and Monitor will monitor the hospital after three months and six months and devise further action plans to improve its outcomes.
I welcome the comments of my hon. Friend the Member for South Cambridgeshire about the need for tougher inspection to root out failure and for a much stronger voice for patients. The old community health trusts were a pain in the arse, if I can say that—
Mr. Stephen O'Brien (Eddisbury) (Con): In quotation marks.
Mr. Syms: Mr. Deputy Speaker is reflecting on that.
However, the community health trusts were the genuine voice of the patients. We have moved through various different models and, to be honest, there is not a big enough voice for patient organisations, which pick up what is being said at the grass roots. If the Government had not been so quick to get rid of the community health trusts, the warning signals would have gone off rather earlier.
We need powers for patients to hold failing hospitals to account. We need an end to box-ticking and targets. Indeed, we have heard the reverse: that outcomes are important, not targets, because when people are under pressure, they will be made to get round targets. We need to expose hospitals that are failing their communities to public scrutiny.
This has been a reasonable debate and there have been some good contributions. I agreed with a lot of what the Minister said earlier, but I did not agree with his stubbornness. I am sure that the civil servants are saying, “Don’t go for a public inquiry, Minister. It’d take too long and be expensive, and things are happening already.” I intend to support my hon. Friends in the Lobby. Even if the Government win the vote this evening—it would be very surprising if they did not—I hope that Ministers will go away and reflect on what opinion in all parts of the House is saying on the matter.
9.36 pm
Mr. Stephen O'Brien (Eddisbury) (Con): We have had an important and comprehensive debate that has been characterised by cogent, balanced and sincere contributions—indeed, one could almost describe them as pleas—from all parts of the House, as befits such a gravely serious issue. It is an issue that must reach beyond party politics.
We must remember that, at its heart, we are talking about the avoidable deaths of up to 1,200 people. Each of those deaths represents family and friends who are left with the heavy burden of grief, which is only intensified by the serious questions that need answering. Furthermore, those deaths can only be correlative to many hundreds more patients who did not receive the treatment that they deserved—treatment that they rightly expect of our NHS. Before going any farther, we must take a moment to remember all those who have suffered and who continue to suffer and grieve because of the failings at the Mid Staffordshire trust. Equally, let us keep in mind the wonderful work of the individuals and teams working across the NHS who have been so badly let down by what has happened in Stafford general hospital.
We have brought a very simple motion before the House today. This is not the moment to knock the Government particularly harshly, although it is clear that there is a continuum of culpability, which extends from the local decision makers to Ministers and, more significantly, calls into question Government policies. Our motion this evening does not seek to apportion blame for the Mid Staffordshire tragedy. Indeed, every speaker has agreed with us and with our motion, other than the Minister and the honourable exception of the Chairman of the Public Administration Committee, the hon. Member for Cannock Chase (Dr. Wright). He said that he would not vote against the motion. He remains to be convinced whether to join us in the Lobby and might just be persuaded—and I hope to try.
Our motion simply calls for an independent inquiry, which the relatives of those who died and the survivors of poor care at the trust both need and deserve. The important point is not just what went wrong, but how and why it did—a point forcefully made by the hon. Member for Wyre Forest (Dr. Taylor), who, with his professional point of view, has a double interest in understanding that—and what must now be done to prevent it from happening again. That is a point to impress upon the hon. Member for Cannock Chase, because unless one understands the past, it is very difficult to move on and ensure that the right things are done for the future.
Despite those wonderful NHS staff, Mid Staffordshire and Stafford general hospital have been blighted, as my right hon. Friend the Member for West Derbyshire (Mr. McLoughlin) said in an intervention, when he gave personal testimony of the most wonderful care that his mother received. The problem extends way beyond the people in Staffordshire, but we heard powerful arguments from my hon. Friend the Member for Stone (Mr. Cash), whose speech not only carried the House, but was redolent of what it means to try to seek justice. He argued forcefully, using evidence that he was able to give only partially, but which would be available in a public inquiry, that the only way to secure that justice would be in a public and independent inquiry.
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