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The Prime Minister:
The hon. Gentleman ought to look at the evidence for the support for the Taliban in Afghanistan. His assumption is that somehow the insurgency has massive popular support, and that the vast majority of the population would go with that insurgency if they had the choice. I do not think that that reflects the situation in Afghanistan. A recent poll showed that only 8 per cent. of the population of Afghanistan supported in any way the Taliban and the insurgency. I believe that most Afghan people want security and safety. I believe that they will support the partnering of British and coalition forces with Afghan forces, and that we have the ability to work with the
Afghan people to defeat the insurgency. I also believe that there are many people associated with the insurgency who are mercenaries or others who do not share the extremist ideologies of the Taliban or al-Qaeda, and may wish at some point to join the ordinary political process and renounce violence.
Patrick Mercer (Newark) (Con): Why has it taken the Prime Minister so long to make up his mind to send the extra troops? Commanders in the field have been asking for an extra battle group for at least a year. Why the delay?
The Prime Minister: Last year we had 8,000 troops in Afghanistan, and at the moment we have more than 9,000 troops in Afghanistan, so the idea that we have not increased our forces over the past year in response to events is completely wrong, if I may say so. On the 500 additional troops whom today we have agreed to send, I think that it was right to lay down conditions that had to be met, partly because the public needed to be assured that everything possible had been done to make it clear that the equipment for our forces was the best possible; partly because we had to assure ourselves that other countries would play a part in the effort; and partly because we needed the Afghans themselves, after the election period, to commit to providing the forces that are necessary for training.
If our strategy is to work, we need the Afghan forces to be trained by British forces and by coalition forces. That is why it was important to get the assurances and, indeed, the practical announcements from President Karzai about the designation of troops to Helmand. I believe that putting conditions on the additional 500 forces personnel was the right thing to do, and I think that the hon. Gentleman is absolutely wrong in saying that we have not acted over the past year. We have done that, and I think that it was absolutely right to lay down conditions that, having been met, mean that we can go ahead immediately and send the additional troops to Afghanistan.
Last week, the two regulatory bodies took action in respect of two NHS foundation trusts, Basildon and Thurrock University Hospitals NHS Foundation Trust and Colchester Hospital University NHS Foundation Trust, and I wish to update the House on that. Separately, questions have been raised about safety standards at other NHS and foundation trusts. I wish to answer those directly and inform the House of the further steps that the Government are taking to improve regulation and safety standards in the NHS.
First, let me set out some important points of context. In 1999, the Government established an independent regulator for the NHS. In tandem, the Department of Health has sought to shine a spotlight on patient safety in the NHS over the past decade by encouraging the systematic publication, analysis and comparison of a range of clinical data. That followed the Kennedy inquiry into events at Bristol. That drive has brought more transparency and a greater focus on safety standards.
At all times, patient safety is our overriding concern, and there are signs of significant progress in the NHS as a whole. Overall, there was a 7 per cent. reduction in the hospital mortality rate in England last year. However, there is never any room for complacency, and patient safety must be the subject of a continuous process of improvement. There is still considerable variation in standards throughout the NHS, from one hospital to another, and in some cases the variation is unacceptably wide. That is the case in respect of Basildon and Thurrock University Hospitals NHS Foundation Trust.
A year ago, surveillance of data by regulators identified a high hospital standardised mortality ratio at the trust. Since then, the regulators have worked with the trust on a detailed improvement plan. That focus had brought improvements, and over the course of this year the HSMR has fallen. However, following unannounced inspections, the Care Quality Commission has raised further concerns with the foundation trust regulator, Monitor, about care standards and the rate of improvement. They agreed that progress was not sufficient, and it was felt that the trust was unable to deliver the improvements necessary within an acceptable time scale.
A decision was therefore taken to intervene and use formal powers by installing new clinical leadership at the trust. Two senior professionals from high-performing trusts will provide experienced medical and nursing support to ensure the early implementation of agreed clinical and nursing changes. A programme delivery office has also been established to oversee delivery. I can assure the House that, as a result of this action, I expect to see immediate improvements and will provide regular updates on progress.
Monitor has also taken action in recent days in respect of Colchester Hospital University NHS Foundation Trust. Last Friday, the regulator used its statutory powers to remove the chairman of the trust. Monitor had, over a period of time, raised a series of concerns with the trust in relation to performance and governance. It has
concluded that those have not been adequately addressed and decided that new leadership is necessary to bring the improvements that patients have a right to expect.
I wish to make it clear to the House that the CQC has informed me that no similar action is necessary at any other trust at this stage. As part of regular monitoring, however, it has identified a small number of other trusts where action is needed to address concerns, and over the weekend there has been further analysis of safety in the NHS. Twelve NHS and foundation trusts have been claimed to be "significantly under-performing" in relation to safety, and a number have a high hospital standardised mortality ratio. While I welcome the shining of a spotlight on to safety standards, it is important to place this finding in context. Given that deaths in hospital have reduced overall-by 7 per cent.-it is possible that the trusts with a high rate are not showing the same level of improvement as the rest. That said, it is vital that these questions are investigated and answered.
It is also important to point out that the report by Dr. Foster analysed a more limited set of clinical and quality data than the CQC. The CQC therefore provides the authoritative voice on these issues, and takes a wider view. The report highlights a number of trusts where there have been issues, but many had already identified them and have action in hand. I can assure the House, however, that where legitimate concerns have been identified, they will be followed up. Again, I will provide updates as and where necessary.
Patient safety must at all times be the highest priority for my Department, the national health service and every single hospital in the country. I expect every trust in England to investigate all serious incidents and unexpected deaths and report them to the national reporting and learning system. This will be mandatory as part of new registration requirements. Following events at Mid-Staffordshire hospital, hospital standardised mortality ratios for all hospitals in England have been published on NHS Choices since April 2009. From next April, the CQC will introduce a stronger inspection regime that provides an in-depth analysis of trust performance in real time. This will also be available online for the public to inspect.
However, as a result of concerns expressed, I have asked the Department to speed up the implementation of this new system and will bring it in from January. Already, 90 per cent. of CQC inspections are unannounced. I wish to see this at least maintained in any new system, with more unannounced visits at trusts giving cause for concern. All trusts will soon be required to screen for MRSA when admitting patients through accident and emergency. Many already do, but I am asking the Department to speed up 100 per cent. adoption. I will also shortly bring forward plans to link hospital payment more closely to safety and quality.
Lord Darzi's next stage review made it the mission of the NHS to focus relentlessly on safety and quality. All trusts must constantly review performance and, where necessary, raise their game. Progress has been made, but where it is not quick or good enough we will always say so and act swiftly. I commend the statement to the House.
Mr. Andrew Lansley (South Cambridgeshire) (Con):
I am sure that the House is grateful to the Secretary of State for making a statement about these two interventions
at NHS foundation trusts, notwithstanding the fact that he is not directly responsible for what happens in those trusts. However, if he is going to take some responsibility, can he explain what he did on or after 4 November, when the inspection report into the prevention and control of infections at Basildon and Thurrock was published on the CQC website, including many of the findings that have subsequently caused so much distress to the patients and public around Basildon and Thurrock? Was Thursday's press release about the intervention by Monitor merely a sacrificial lamb ahead of the Dr. Foster report?
Now that the taskforce has gone into the Basildon and Thurrock trust, does the Secretary of State agree that it is vital that, within days, it advises Monitor on whether the trust has, or does not have, the necessary leadership, clinical and otherwise, to take it forward for the future?
Earlier this month, Monitor made it clear that it was considering intervention at Colchester because the trust appeared to have breached the terms of its authorisation. Did the Secretary of State have any correspondence with Monitor about that, and did he have a view about it at the time?
In his statement today, the Secretary of State seems to have been talking almost interchangeably about the CQC and Monitor, but it will be evident to many, as it was to me, that they were not speaking from the same page in relation to Basildon last Thursday and Friday. Will the Secretary of State, like me, make it clear to the CQC and Monitor that the relationship between those two regulators will have to be closer and more harmonious than it has been in the past if it is to work effectively?
The Secretary of State's statement centred on two individual trusts, but the repercussions will be felt across the country, not least because of the worrying data in the Dr. Foster report, none of which should come as any surprise to the Secretary of State. However, instead of listening to the messages in the report, the Government set out over the weekend to shoot the messengers. They are quite wrong to do so, and that will not restore public confidence.
What is required, I am afraid, is evidence that the Government learn from the lessons of these serial failings. Why do I literally have to stand at this Dispatch Box again responding to issues very similar to those we saw at Maidstone and Stafford? Ministers each time call it an isolated case; each time they say, "We mustn't be complacent and it must never again happen"; but each time they fail to tackle the heart of the problem.
We know that the NHS is capable of delivering some of the best health care in the world; we know that some hospitals-such as my own, Addenbrooke's, in Cambridge-are among the best in the country and do remarkably well. However, to understand why some hospitals do not deliver acceptable standards, we just have to look at the lessons of the recent past: Stoke Mandeville, 2006; Maidstone, 2007; Mid Staffs, March this year; today, Basildon and Thurrock trust. Recurrent themes have occurred in each of those hospitals: waiting time targets prioritised over patient care; clinical priorities distorted by Government targets; a focus on financial issues at the expense of patient care; senior management at board and strategic health authority level prioritising national targets and policy objectives over the delivery of quality care for patients; primary care trusts focused
on the cost and volume of treatments, rather than performance management of the quality of care for their public; and a lack of leadership and accountability, with front-line staff finding that the concerns they have raised are not being listened to.
When will the Secretary of State acknowledge that the Government must do something about this, and in particular scrap the top-down process targets that divert attention away from patient care towards tick-box questionnaires? It is clear that, where the regulatory system is concerned, the Government will have to abandon the health check published by the CQC last month. Will the Secretary of State agree that he should do so and instead have a rating system that actually relates to what patients experience in hospital and the results of the treatment they receive; that is based on outcomes, not processes; that has more on-the-spot inspections; that is based on patient experience and their reports of their outcomes; and that follows up unresolved complaints?
Another reform is to give patients and the public the power to influence how care is provided in the NHS. The Government scrapped community health councils and have never since allowed there to be an effective patient voice in the local community. Will the Secretary of State ensure legal protection for staff who blow the whistle on failings in their trusts, and that the NHS adopts, as it must, a "no-blame" culture in which the penalty is for the cover-up, not the error?
The public need to be assured that the Government are doing all that can be done to ensure the safety of patients in our hospitals, but today, how can they be? We have conflicting analyses from Dr. Foster and the CQC. We have Ministers out of their depth and in denial. We have an NHS that has the capacity to deliver the best, but with neither the incentives nor the leadership in place to make it happen. What did we get from the Secretary of State? We got processes, rather than purpose, and another statement that "this must never happen again". It is just not good enough.
Andy Burnham: I will deal with the hon. Gentleman's questions in turn, but let me deal first with his last point. I think he was accusing us of complacency, or of failing to address directly the issues that matter to patients. Ever since coming into this job, I have said that I do not want to over-claim for the NHS. Where it is good we should say so, but where there needs to be improvement, we will not flinch from taking the action necessary to get it.
It is important for the hon. Gentleman to acknowledge that the data on which the judgments in question are being made have been encouraged by this Government, following some of the events that he mentioned. The culture of challenge and analysis of clinical data has been at the heart of our plans for improving the NHS, which is why what he said was unfair and misdirected. It was this Government who asked the regulators to use the HSMR data to ensure that there was challenge. Because the Healthcare Commission, the predecessor to the CQC, was looking at those data, it was able to take the action that it did in relation to Mid Staffordshire.
I will always accept hearing from the hon. Gentleman that we can do more and should not be complacent, but I point out to him that there is no complacency. We have made changes, and thinking back to what was in place
before, I do not believe that it was possible to make judgments about the clinical standard and safety of care across the NHS, as it is today.
I shall deal with some of the hon. Gentleman's specific points. He particularly asked me about 4 November, when the report was submitted by the CQC. He has to accept that, as I said in my statement, the matter goes back further than that. Because of the system of regulation that we have, and because there is routine monitoring of data, action had been taken much earlier and the two regulators had been in contact about Basildon and Thurrock NHS foundation trust. Action was in hand and a plan had been developed, and it was because the regulators felt that progress against that plan had not been sufficiently swift that they decided to escalate their involvement. It is not fair of the hon. Gentleman to say that there was a knee-jerk response, because there had been a long process in place that had failed to produce the necessary improvements, and an unannounced visit by the CQC in October highlighted some of the concerns that then required the escalation.
On Colchester, the hon. Gentleman will know that Monitor has been expressing concerns about standards for some time and has been in dialogue with the trust. I support the regulator, in this case Monitor, in taking the action that it believes is necessary to improve standards for patients quickly. I shall make no apology for that.
The hon. Gentleman mentioned the relationship between the CQC and Monitor, and I agree that there needs to be close co-operation between the two regulators. I accept that there were lessons to be learned following the events at Mid Staffordshire about how that relationship could be improved, and I accept that he is right to say so, but there has been close co-operation on Basildon and Thurrock, and that has led to the action that I have described.
On Dr. Foster, the hon. Gentleman asked, "Why shoot the messenger?", but I do not believe that the Government did that. As I said, we have encouraged the publication of the relevant data across the NHS. He needs to take a step back, if he does not mind my saying so, because the patient safety rating in this case is disputed by some of the trusts in question. He will have seen yesterday that some of them issued a pretty strong rebuttal to the concerns raised, and that is all part of the process of challenge. We did not dismiss the Dr. Foster findings; indeed, it was on the back of those concerns that I asked to be assured that no action similar to that taken at Basildon and Colchester needed to be taken against any other NHS trust. I received that assurance from the chair of the CQC over the weekend.
As he always does, the hon. Gentleman made a big criticism of Government targets and suggested that they run counter to improving patient safety in the NHS. The best hospitals are meeting performance standards targets that matter to patients and financial targets, and providing high-quality, safe care.
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