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Mr. Geoffrey Robinson (Coventry, North-West) (Lab):
Today, in the light of the inclusion of University Hospitals Coventry and Warwickshire NHS Trust in the 12 trusts
that were analysed, I spoke to its medical director, Dr. Richard Kennedy. He had taken great exception to the findings of Dr. Foster, particularly those in respect of the standardised mortality ratio. The hospitals had provided Dr. Foster with amended data a month ago to conform with the new arrangements that were being sought, but the Dr. Foster organisation had chosen not to take any notice of those data or to include them in its findings. Will the Secretary of State take that up with the organisation, and ask why it happened?
Andy Burnham: When there have been such instances, I think it important for the facts to be established, and for clarification to be provided for trusts in that position if it is needed. It is not acceptable for concern to be raised at local level which is not justified. My hon. Friend has made his point very clearly, and I hope it will be followed up by both the trust and Dr. Foster. However, as I said to the hon. Member for North Norfolk (Norman Lamb), the hospital standardised mortality ratio is not in itself a verdict on hospitals. It is simply a trigger for investigation.
Mr. David Amess (Southend, West) (Con): Basildon hospital enjoyed a first-class reputation when I was Member of Parliament for Basildon, and I am shocked and saddened by what has happened. If it is true that patients are to be transferred from Basildon to Southend, what assistance will the Secretary of State give Southend hospital to help it to cope with the situation?
Andy Burnham: I am sure that it was not just the hon. Gentleman's departure that led to what has happened. Having served with him on the Health Committee, I know of the great interest that he takes in health matters. It is and will remain our policy for patients to have full choice across the national health service. We want to see the regular publication of higher-quality data, and that is at the heart of the new regulation regime that will be introduced next year. We have also introduced NHS Choices. If more patients choose to use Southend, that is their choice, and Southend will of course be paid accordingly by the necessary commissioners.
Mr. Ken Purchase (Wolverhampton, North-East) (Lab/Co-op): Will the Secretary of State accept that the obsession with structures, trusts and foundation trusts is entirely irrelevant to the level of care that we expect in our hospitals? Will he understand that the spending of a million pounds a throw on foundation trusts is simply a waste of money, and that the best work he can do is to put more money into front-line services, get rid of all this "architecture"-I think that that is what new Labour calls it-and concentrate on delivering a health service worthy of the name?
Andy Burnham:
I hear what my hon. Friend says, but I am afraid that I disagree with him. If he speaks to chief executives and the senior leadership in any foundation trust in the country, he will find that the most helpful process they have been through is the process of applying for foundation trust status, as that gives them information about their organisations that they did not have before. The process has led to rising standards across the health service. While we cannot be complacent and we want to improve standards in foundation trusts where we need
to do so, in many cases this reform has led hospital trusts to raise their game and improve what they do for local people.
James Brokenshire (Hornchurch) (Con): The Secretary of State must appreciate that throughout the country there will still be considerable uncertainty as to the standards of care provided at hospitals. In his statement, on the one hand he implied that the CQC was authoritative, yet on the other hand he said that, where legitimate concerns had been identified, they would be followed up. Can he be more specific on how they will be followed up, and assure the House about the timetable for this, so we can get some greater certainty given the information that has been provided over the past few days?
Andy Burnham: I can indeed give the hon. Gentleman that assurance. That is the job of the CQC: its job is both to provide regular supervision of performance across the national health service, and where concerns are identified, to intervene and ensure that the necessary action is taken. It acted in respect of Basildon and Thurrock, and because it had not seen sufficient improvement, its concerns have now escalated and it is working in tandem with Monitor. That is how the process works. Where there are concerns about other trusts, it will follow them up with those trusts. I repeat what I said in my statement: I will update the House where any action has been taken.
Dr. Richard Taylor (Wyre Forest) (Ind): As the Select Committee on Health has recently completed a report on patient safety that contains many helpful conclusions and recommendations, will the Secretary of State use his good offices to ensure that we have a full debate on patient safety?
Andy Burnham: I certainly agree that patient safety is of the highest importance and that it is crucial that this House devotes time to debating how to raise standards of patient safety. It is the one area where we can confidently say that there must never be complacency. There must be a continual process of interrogation of standards at all trusts, and just when a trust feels it is doing well enough, it should look again and improve its performance even further. I agree with the hon. Gentleman that we need to devote more time to debating patient safety on the Floor of the House.
Bob Russell (Colchester) (LD): I am grateful to Mr. Speaker for agreeing to my request for a statement on Colchester hospital. There is great concern and anxiety among the local population, and there is a need for urgent steps to be taken to give reassurance and to bolster the morale of staff throughout the Colchester Hospital University NHS Foundation Trust. That said, I attended the trust's annual meeting, and what was said there does not reflect what we are hearing now. There appears to be a battle between the various quangos. Does the Secretary of State agree that we are witnessing the consequences of a box-ticking, target-setting agenda and that there is an urgent need for local democratic accountability?
Andy Burnham: I have to say that I do not agree with the hon. Gentleman. While I respect his views about his local trust, the regulator identified a number of performance and governance concerns, and it asked for a process of improvement at the trust. That did not follow within the time scale requested. I will defend the regulator in taking firm action, where standards need to rise. The hon. Gentleman will know that the foundation trust model allows patients to become members of a trust and to hold it to account. I encourage him and his constituents to use the voice that that reform gives them to hold their local trust to account and have their say in the delivery of local health care.
Mr. Kevin Barron (Rother Valley) (Lab): My right hon. Friend said earlier that NHS patient surveys always show very high satisfaction scores. Does he agree, however, that such surveys are not a good way to measure the variation in standards and safety in the national health service and that we need to make sure that we have the right mechanisms in place so that the best that is delivered in any hospital in the United Kingdom is achieved in every hospital in the United Kingdom?
Andy Burnham: I agree with the Chairman of the Health Committee that patient satisfaction is an important part of quality, but it is only a part of quality. It needs to be set against clinical safety standards and, of course, clinical effectiveness; it is crucial that the broadest possible view is taken of quality in the NHS, and that was the conclusion of Lord Darzi's next stage review. I assure the Chairman of the Health Committee that as we develop plans for the NHS in the coming period, we will seek to embed the conclusions of that review in the payments structures of the NHS, so that there is a relentless focus on quality and safety in every NHS organisation.
Bob Spink (Castle Point) (Ind): Basildon hospital serves my constituents and it has some wonderful, caring staff, but since 2005, I have raised serious problems with the trust, which have not yet been addressed. On a specific point, may we empower patients and families by routinely providing them with personal antimicrobial products, so that they can actively participate in preventing the spread of health-care-associated infections in Basildon, as well as in all UK hospitals?
Andy Burnham: I hear what the hon. Gentleman says. I have not visited that hospital recently, but I am confident that, as happens in many other hospital trusts now, alcohol gels and other products will be freely available in the hospital environment for people to use to bear down on rates of infection. It is also important to say that rates of infection have decreased significantly right across the national health service, in respect of not only MRSA, but clostridium difficile. He is right to say, again, that there can be no complacency on this issue, and I am sure that the leadership at the trust will have heard his comments today.
Mr. Bernard Jenkin (North Essex) (Con):
May I remind the Secretary of State that new Labour was originally elected on the slogan "24 hours to save the NHS"? That now rings all too hollow to people who rely on Colchester general hospital for their health care. Will he reflect on that and explain why he is still having
to make announcements of this nature, given that health expenditure has doubled since the Government were first elected?
Andy Burnham: The hon. Gentleman has a short memory about the state the national health service was in during the 1990s, when people routinely waited hours on end in accident and emergency departments up and down the country. I was looking last week at the patients charter, which, in the mid-'90s, set an 18-month maximum wait for treatment and a year's maximum wait for heart bypass operations. Will he tell us how many people waiting for those heart bypasses never got to have the final operation, such was the state of the national health service in those days? Improvement has taken place in the NHS, but I say again that I do not over-claim for the NHS. When it needs to be better, I will say so and we will take the necessary action to make it happen.
Mr. John Baron (Billericay) (Con): Having met the management of Basildon hospital on Friday and toured a number of the wards, including the accident and emergency wards, I have been assured by the management and clinical staff that the hygiene recommendations of the CQC report have been implemented in full, with the help of a nursing taskforce. The key concern for my constituents is safety for patients in the hospital and for those about to go into it. How quickly can the Health Secretary report back to us on the progress and effectiveness of Monitor's intervention for the sake of those patients and of the many people in Basildon hospital who are doing excellent work?
Andy Burnham: I welcome the close interest that the hon. Gentleman is showing in this issue. I want to give him the facts so that he can then make the necessary statements to local people in his constituency about the performance of the trust. I do not seek to put any spin on it; he can have those facts to show whether improvement is coming quickly enough.
As I said to the hon. Member for Brentwood and Ongar (Mr. Pickles) a moment ago, improvement has been made this year on the mortality ratio. I shall give the hon. Member for Billericay (Mr. Baron) those figures, but the judgment is that the progress needs to escalate. The trust now has the benefit of two senior professionals from one of the highest-performing trusts in the country, both on the medical and the nursing side. We expect them to start work immediately and a programme office based at the trust will be monitoring and overseeing progress. I shall give him updates as and when they are available, but I agree with him that improvements need to be immediate.
Mr. Peter Bone (Wellingborough) (Con): Basildon is one of seven trusts that have been shown to have a high mortality ratio not just for one year but for five years. One of those other trusts is Kettering, which serves my constituency. What will the Secretary of State do about the other six trusts identified by Dr. Foster?
Andy Burnham: May I say to the hon. Gentleman that this ratio was developed by Professor Brian Jarman, and we very much encourage its use? However, it is not of itself a verdict on a trust's performance. It is simply a trigger that then gives cause for more investigation and inquiry. In many cases, trusts that have had a high mortality rate have been able to bring it down. There may be a number of reasons why a particular trust has a high standardised mortality ratio and the circumstances need to be investigated. I assure the hon. Gentleman that those trusts will be investigated. If we need to take further action, of course, we will.
Mr. David Heath (Somerton and Frome) (LD): It is not just about chief executives and managers. Every single surgeon, doctor, nurse and other professional has a professional duty of care to reduce risk. To that end, and to help them, can the Secretary of State tell me what progress has been made in introducing the checklist procedure for individual procedures that was pioneered in the Johns Hopkins hospital and that is shown to reduce morbidity and mortality rates? Is that being taken forward throughout the health service?
Andy Burnham: I assure the hon. Gentleman that it is being taken forward. If he does not mind, I will write to him with a detailed progress report on how adoption is proceeding through the national health service. I agree about the techniques pioneered by an institution as eminent as the Johns Hopkins university hospital in Baltimore. We have worked and looked internationally to use the best standards. The NHS has a reputation for learning and implementing quickly some of the best standards from around the world, but I will give the hon. Gentleman an update along the lines that he seeks.
Mr. Andrew Pelling (Croydon, Central) (Ind): Does the Secretary of State accept that it causes consternation and concern when the CQC rates hospitals as good and then Dr. Foster reveals such difficulties? It undermines confidence. In my constituency, in the Mayday hospital, there were issues to do with process that unfortunately led to constituents passing away, but then the CQC rated my hospital as good. Should I now feel that the CQC process for my hospital should be questioned?
Andy Burnham: I say again to the hon. Gentleman that the CQC is the authoritative voice on matters of safety and quality in the national health service. It was set up by Parliament to do that job. It takes a broader view of safety and quality in the NHS, looking across a much broader range of indicators than those used by Dr. Foster. However, I do not dismiss the work that has been done by Dr. Foster. In the case of a number of trusts that have been identified as a result of this work, there needs to be a further process of inquiry to establish whether the concerns are justified. The methodology used is new, and it needs to be questioned so that the hon. Gentleman can give clear advice to his constituents. I say again that the CQC is the leading and authoritative body set up by Parliament to do that job.
Points of Order
5.48 pm
David Taylor (North-West Leicestershire) (Lab/Co-op): On a point of order, Mr. Deputy Speaker. Can you say whether you have had any indication from the Chancellor of the Exchequer that he intends to confirm in a statement that non-domicile tax status will not apply to rich kids living in Richmond and Kingston unless and until those two boroughs secede from the United Kingdom?
Mr. Deputy Speaker (Sir Michael Lord): I am sure that it will be no surprise to the hon. Gentleman to hear that I have had no request for such a statement
Mr. Andrew Pelling (Croydon, Central) (Ind): On a point of order, Mr. Deputy Speaker. I enjoyed seeing the Christmas tree going up over this weekend when I was working here at the House, but I note that it was blown down this morning. Is there an appropriate place to raise issues about the safety of visitors and people working on the parliamentary estate now that we have seen the tree blown down? Is there a precedent for the Christmas tree falling down and is it a bad omen for anybody?
Mr. Deputy Speaker: All I can say to the hon. Gentleman is that steps are being taken to ensure that the tree is re-erected and I am sure that it will be put back safely.
Financial Services Bill
[Relevant Documents: The Fourteenth Report from the Treasury Committee, Session 2008-09, Banking Crisis: regulation and supervision, HC 767, and the Government and Financial Services Authority responses, HC 47, Session 2009-10.]
5.49 pm
The Chancellor of the Exchequer (Mr. Alistair Darling): I beg to move, That the Bill be now read a Second time.
As the House well knows, the whole world economy has been hit by a severe financial crisis, resulting in the worst global downturn for well over 60 years. Fundamentally, the crisis was caused by the failure of people operating in the market around the world fully to understand and keep up with the consequences of financial innovation and globalised markets: quite simply, people took on too much risk and became too exposed in relation to some products. There are clearly lessons to be learned by Governments, regulators and central banks, who in too many cases underestimated the threats posed by system-wide risks and did not fully appreciate the implications of financial activity outside the regulatory scope.
It has been necessary to make some major changes, including in the way firms are managed, which as I have said on many occasions is the first line of defence, and in relation to the quantity and quality of capital the banks hold, and in the way regulators monitor firms. Over the last year or so, we have already taken action to ensure that the UK authorities have powers to deal with failing banks, as well as to protect consumers and taxpayers. The Banking Act 2009 established a new permanent special resolution regime that has allowed the authorities to deal with failing banks and building societies. As the House knows, we have already used that measure in respect of the Dunfermline building society earlier this year. Similar powers in the emergency legislation that allowed us to nationalise Northern Rock also allowed us to deal with Bradford & Bingley when it got into difficulties. The House saw the problems we had before we had those powers, so the Act has provided us with a useful way to resolve things if banks get into difficulty.
In addition, the Financial Services Authority is implementing the conclusions from Lord Turner's recommendations on how to strengthen the regulatory regime. We have also seen the proposals on reform of corporate governance recommended by Sir David Walker in his report last week. Although those reforms may not have received as much attention as his proposed reforms of bankers' pay, they are all important and they all need to be implemented.
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