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Is the hon. Gentleman really saying that A and E departments were safer before the introduction of the four-hour target? I am not sure that he wants to make that claim. I remind him-it almost seems to have slipped his memory and that of his colleagues-that the patients charter circa 1995 included a four-hour A and E standard, and a proposal to reduce that target to two
hours once it had been embedded. I do not therefore believe that it is possible for Conservative Members to stand at the Dispatch Box and claim that setting such targets is the wrong thing to do.
The hon. Gentleman mentioned the need for patient feedback and I agree that there is a need for better feedback from patients about the standards of care that they receive. That is why we introduced NHS Choices, with the ability for patients to put their comments online. However, I agree about the need for better patient satisfaction data, service by service, throughout the NHS. I have said that I want that published systematically, and a new link to payment for hospital services.
I assure the hon. Gentleman that there is legal underpinning for whistleblowing throughout the system, and we should all do what we can to support staff who want to raise concerns about standards in their workplace.
It is important to acknowledge the fine work and standard of care across most of the NHS. Indeed, there will be many fine clinicians doing important work in the hospitals that we are discussing, so it is important not to tar everyone with the same brush.
However, the revelations raise serious concerns. For example, a taskforce has been sent into Basildon, but will we get to the bottom of how the failures occurred in both hospitals so that we understand who was responsible? What about the clinicians? Each has a duty to their patients. Will they be held to account for any failures? What about the people on the board who have responsibility for patient safety? Will they be held to account?
The CQC says that there is no evidence of another trust's being in the same category as Basildon and the Secretary of State repeated that assurance. Yet that is precisely what we were told in the aftermath of Mid Staffordshire-that it was an isolated incident. How can we have faith in the CQC's standards given what happened with Mid Staffordshire?
Are Dr. Foster's concerns being thoroughly investigated, particularly the extraordinary statistic that 39 per cent. of hospitals have failed to investigate all unexpected deaths or cases of serious harm? Surely every case must be thoroughly investigated.
There is now a series of cases in which there is an extraordinary mismatch between rating and the reality: Mid Staffordshire, baby P, Basildon; and eight of the 12 cases that Dr. Foster raised were rated good or excellent. Does not that completely undermine confidence in the system of regulation? Do not we end up with a state of paper safety, but not real patient safety?
The Secretary of State will know about the NHS Confederation report "What's it all for?", which is a damning critique of the system of regulation in this country. It highlights that more than 60 bodies inspect hospitals, with no clinical engagement in responding to all those organisations. One person would take 491 years to provide all the data to the national regulators. What has happened to that report? Are the Government ignoring it or acting on it? If they are acting on it, how are they doing that? The report highlights that several bodies nationally are responsible in some way for patient
safety: the CQC, Monitor, the National Patient Safety Agency, the Health and Safety Executive. Who is ultimately responsible? Is there not a danger that no one ends up being accountable?
We hear that Monitor has a list of 11 NHS foundation trusts where there has been a significant breach of standards, which it is investigating. The CQC is investigating a few hospitals. Dr. Foster has concerns about 12 hospitals. Are they all the same hospitals? Are the different bodies talking to each other? Have the local primary care trusts been informed in every case? Do not the public have a right to know which those hospitals are?
Does the Secretary of State agree that ultimately openness and full information are more effective at driving up standards than tick-box self-assessment, without clinical engagement? Does he agree that it is hard to justify the increase in the pay of the chief executives at Basildon and Colchester by 15 per cent. and 11 per cent. to £150,000 when serious concerns were being raised about standards?
Given the accumulation of evidence and the fact that hundreds of people appear to have lost their lives unnecessarily, is not there a case for an independent investigation of regulation to consider its role, self-assessment, the lack of clinical engagement in providing data to the regulators, the role of targets-yes, they must be investigated-and that of financial incentives? Do we not owe it to all those who have been affected by the scandals?
The hon. Gentleman made some sweeping statements about the numbers of deaths. It is important to say that the hospital standardised mortality ratio is a trigger for investigation, but I would caution him against thinking that in and of itself it gives a verdict on hospital performance. It is very important-and only fair to people working in the national health service-that we think of it in those terms. The ratio can raise questions and concerns that need to be addressed, but we should not treat it as a verdict on performance, because it is not that.
The hon. Gentleman began by saying fairly that a good standard of care is being provided across the NHS, and it is right to remember that in moments such as this. There are 14 million hospital admissions every year and, as we have said many times, patient satisfaction with the NHS is running at historically high levels. He asked me how failures occur. Obviously, in respect of Basildon and Thurrock, that is now the subject of detailed work, and I will update the House as and when I have more information to give.
In respect of this case, and that of Colchester, it is important to say that the regulators have said that it is not in the same category as Mid Staffordshire NHS foundation trust. It is important to make that distinction. However, that is not a recipe for complacency and it is crucial that the questions raised are properly investigated and conclusions reached and disseminated. I assure the hon. Gentleman that that is what will happen in this case.
The hon. Gentleman asked whether every case should be investigated, and he referred to the Dr. Foster data in that regard. I agree with him that those are very important
and I, too, would want to ask further questions about those data and how that finding was reached. He should know that it is a requirement of the National Patient Safety Agency for every serious incident or death to be investigated, and I reiterated that point in my statement this afternoon.
The hon. Gentleman questioned the role of all the different bodies commenting on such matters. After the creation of a culture of challenge and benchmarking and the use of data across the system, it is inevitable that there will be many voices in this debate, but the Care Quality Commission is the authoritative voice that this House should listen to. It was set up by Parliament to provide authoritative advice on such matters.
The hon. Gentleman also questioned the process of self-assessment as used by the CQC. That will be the bedrock of any regulatory system, but he will know that the CQC overlays that with a range of other measures and data that it receives from a range of sources. It is that 360° analysis of what is happening at any particular hospital trust that triggers its decision on intervention.
The hon. Gentleman also asked about pay. I acknowledge the concerns that people have about excessively high pay across the public sector, but particularly in the national health service. I know that he speaks for many people in voicing those concerns. Of course the boards of foundation trusts are independent of Government, but we wrote to them some months ago to remind them that they should set pay in accordance with wider pay trends in the public sector and, at a time such as this, they should at all times show restraint in setting awards.
Andrew Mackinlay (Thurrock) (Lab): My right hon. Friend the Member for Basildon (Angela E. Smith) wanted to be here but she is in Committee. However, although I have been working closely with her over the weekend, my question is my own.
"a poor care environment in A&E...inadequate arrangements to treat children...breaches of infection control,"
high morbidity and mortality rates, and general problems with health care standards and governance. Does the Secretary of State share my view that it is incredible, untenable and unacceptable that the chief executive has not decided to step aside? I include in that some other executive directors, particularly the one charged with ensuring oversight of and compliance with the cleaning contract. There is a question of public confidence in Basildon and Thurrock. Basically, Monitor and the Secretary of State need to address it with some urgency. It is unsustainable that the people who have been found by Monitor, in the words that I have quoted, to be in such significant breach should still be in post this afternoon. I understand that there is a problem-
My hon. Friend is right to say that every possible step must be taken to improve standards, but the test that Monitor must apply-I met Monitor last week and discussed this in detail-is: what action is most likely to achieve the quickest improvement and turnaround at the trust? That is what matters, I would say, to his constituents and those patients served by the hospital. The judgment is: how can the trust get improvements as quickly as possible? In this case, Monitor's judgment was that action was needed to strengthen the clinical leadership in the trust-both the medical and nursing leadership-but that standards were likely to improve more quickly by keeping the action plan that had been developed under the leadership at the trust. Monitor assured me that the action plan that had been developed was a good one, but said that it did not believe that progress on it had been sufficient to date, hence the need for the escalation of its activities.
I hear my hon. Friend's further concerns about the cleaning contract at the trust. I am afraid that I do not have a specific answer to give him today, but I will write to him in detail on that matter.
Mr. Eric Pickles (Brentwood and Ongar) (Con): I am very sorry to tell the Secretary of State that the situation with Monitor is not quite as he described in his statement. Monitor has had concerns about the level of mortality in Basildon for more than a year, but its intervention was slowed down because, in its words, it is complicated and difficult to intervene. My constituents deserve something better than to be held back by a process that has become complicated and difficult. After Mid Staffordshire, "complicated and difficult" is not a reason for non-intervention.
Andy Burnham: I hear what the hon. Gentleman says. I asked the same question of Monitor and the CQC last week, which was: when were the concerns identified and has there been improvement? I am assured-I will write to him with the figures-that there has been a discernible improvement on the mortality ratio at the trust over this year. I will give him the figures that indicate that the plan that had been developed, which I referred to in my answer to my hon. Friend the Member for Thurrock (Andrew Mackinlay), is having some effect. Nevertheless, I hear what the hon. Gentleman says about whether that improvement has been speedy enough. That was why a decision was taken to escalate the action. There has been a significant focus on the trust over this year, which suggests that the regulatory regime picked up the concerns at the trust. I expect to see immediate improvements as a result of the actions that have now been taken, and will report to all hon. Members on those improvements as they follow.
Jim Dowd (Lewisham, West) (Lab):
Since the House rose for the summer recess, I have received extensive cardiac treatment at Lewisham hospital and a bypass operation at King's College hospital in September. The service that I received throughout that period, and which I continue to receive, has been exemplary. As a beneficiary of the services of the NHS, I cannot speak highly enough of the services in south-east London, which brings me to the Dr. Foster analysis. When I was at University Hospital Lewisham just this morning, as
part of my rehabilitation programme, I took the opportunity to speak to the chief executive and the chairman of the trust. They are at some loss to understand how on the basis of the same data, both the Care Quality Commission and CHKS, the leading independent-sector supplier of health intelligence, managed to find it good, with CHKS putting it in the top 40 performing hospitals in the-
Jim Dowd: What action can my right hon. Friend take to ensure that people are not given conflicting information on the basis of the same data, which serves only to undermine the NHS and the people who work in it?
Andy Burnham: I am grateful to my hon. Friend for that question and I note his praise for the staff at both King's College and Lewisham hospitals, who will hear his kind words. It is important that my hon. Friend speaks in that way, because at moments like this, there is a tendency to cast a cloud over all the people working in the NHS, yet, as we all know, the vast majority of our constituents receive outstanding care from the NHS and it is crucial that these issues are at all times kept in context.
Contrary to what the hon. Member for South Cambridgeshire (Mr. Lansley) said, I am not shooting the messenger. Nevertheless, the safety ratio used for this piece of research is a new calculation and, as was rightly said, there has been some challenge to that calculation by a number of hospital trusts. I think that it is a healthy thing that there is a process of challenge in respect of these matters of the utmost importance, but I would also defend the right of hospitals around the country to counter suggestions if they believe that they give an unfair portrayal of the standards at any particular trust.
Mr. Graham Brady (Altrincham and Sale, West) (Con): It is not just the safety ratio that some trusts have challenged. The Health Secretary will know that the South Manchester trust has flatly rejected some of the factual findings in the Dr. Foster report, particularly with regard to being accused of leaving foreign bodies in patients after surgery. It says that there is no evidence of that having happened at all at the trust. Will the Secretary of State rapidly give a clear statement to the House setting out where there have been factual errors in the work that has been done?
The hon. Gentleman is right to refer to the strong words from South Manchester NHS trust. I do not think that there is any debate about the data that have been used, although there is some debate about the methodology that has then been applied to those data and the resulting scores. For instance, if we look at the Basildon and Thurrock trust, we see that it scored within expected limits on nine out of the 13 measures looked at by Dr. Foster, and it scored 98 out of 100 on one of them. I do not draw attention to that in order to dismiss the work that has been done, but it is nevertheless a complicated picture and it is not entirely clear why a score of 0 out of 100 was merited. It is important to recognise that this methodology has not
been used before. It is helpful that there is a process of challenge about safety in the NHS because there always should be an ongoing dialogue about improving safety, but some trusts are, I think, justified in raising concerns about this methodology if they do not believe that it fairly reflects the standards at their trusts, especially if that portrayal gives rise to undue concern among the local community. The hon. Gentleman is right that there should be a process of interrogation of this methodology, but I am sure that that will happen in the coming days and weeks.
Paddy Tipping (Sherwood) (Lab): Is it not the case that patient satisfaction at these two hospitals and across the acute sector as a whole is very high, with 90 per cent. of patients judging their care to be "good to excellent"? Despite that, what more can be done to put patients at the centre of the NHS so that they receive good-quality treatment rather than being merely the passive recipients of care?
Andy Burnham: My hon. Friend makes a very important point. He is right that the latest findings on patient satisfaction in the NHS show that 93 per cent. of patients rate the care that they receive as excellent or good. I have asked myself precisely the same question as my hon. Friend and I referred in my statement to my intention to bring forward proposals soon about how we can link payment for hospitals more closely to patient satisfaction and quality, as indicated in Lord Darzi's next stage review. I think that it is the way forward. It will enable us to focus the minds of those working in the management of hospitals on patients and, as my hon. Friend suggests, to make them the centre of concern. We will shortly present plans to increase the proportion of the tariff system that is accounted for by quality and safety.
Mr. Deputy Speaker: Order. A number of Members are seeking to catch my eye. Unless we have much briefer questions-just one question each-and much briefer answers, a number of Members will be disappointed.
Mr. Michael Jack (Fylde) (Con): Blackpool, Wyre and Fylde Hospitals NHS Foundation Trust has worked very hard to reduce hospital infection rates at Blackpool Victoria hospital, and was deeply disappointed by the Dr. Foster analysis. What steps will the Secretary of State take to reconcile those different assessments of safety in hospitals so that the public can be reassured that their local hospital is as safe as the management say it is?
Andy Burnham: I have checked, and I know that the trust has been working hard across the board to improve safety standards. It has good progress to show for that work. I can tell the right hon. Gentleman and his constituents that the authoritative voice on these matters is the Care Quality Commission-although there will always be other voices challenging its assessment-and I refer him to the commission. There will, of course, be debate about the findings over the coming days.
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