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John Hemming (Birmingham, Yardley) (LD):
I, too, welcome the Prime Minister's statement. I must declare an interest as chair of the Justice for Families campaign, which resists injustices against families on the basis of the best interests of the child. The challenge always is
that, when people say, "It's better for the child", it is quite difficult to question the injustice. Sadly, many things similar to the child migrant programme, albeit on a smaller scale, continue today, and families are emigrating from this country to escape the family courts. What confidence does the Prime Minister have that a Prime Minister in 20 years will not be making a similar, but smaller scale, apology?
The Prime Minister: I agree with the hon. Gentleman, and if he has any evidence of abuse that should be dealt with, he should bring it before us.
Mr. Geoffrey Robinson (Coventry, North-West) (Lab): The Prime Minister will have heard the remarks of my hon. Friend the Member for Gloucester (Mr. Dhanda), but even those of us who have not been deeply involved know that this has been a sorry and very sad saga. Will he ensure that the money, which is so appreciated, is found and willingly, usefully and generously disbursed to those who have had so much to bear over all these years?
The Prime Minister: My hon. Friend is absolutely right. We are disbursing the money as quickly as we can to those in the greatest need, and we are working directly with individual families to ensure that their needs are met.
Mr. Shailesh Vara (North-West Cambridgeshire) (Con): In order to appreciate the scale of the problem, can the Prime Minister give an indication of the number of children sent abroad, and does he have any idea of the number who might still be alive?
The Prime Minister: This information is being collected over time, so I think I should give a more updated report to the hon. Gentleman at a later date, rather than give him figures that might turn out not to be correct.
Judy Mallaber (Amber Valley) (Lab): My constituent, Pat Hewkin, who sadly died last year, lost her younger brother when she was six when child migrants were sent to Australia. I was honoured to be there when her brother came over for the first time and they were reconciled. I saw the joy, the sadness and the horror of their having to tell their stories, but it was absolutely wonderful to see how they were reconciled and able to meet each other-thanks to the work of the Child Migrants Trust and Margaret Humphreys. Pat was also able to go over and visit him in Australia. I hope, therefore, that the work of the Child Migrants Trust will continue to be supported because to see those families that were split asunder able to meet each other again was a very emotional thing to witness.
The Prime Minister: I am grateful for the work that my hon. Friend has done. Amid the tragedies of separation, we can see, in that particular family, the joy also of reconciliation, and we wish to make that possible for many more families.
Andrew Selous (South-West Bedfordshire) (Con):
This was a very poignant statement for me, because, at the age of five-in 1967-I travelled to Australia for several months with my mother, who was an Australian citizen, to spend a very happy time with my grandparents. It is
truly shocking to think that, at the same time, this country was officially sending children against their will to Australia where they had such a grim time. May I say that sorry is often the hardest word and commend the Prime Minister and my right hon. Friend the Leader of the Opposition for what they have said today? It was the right thing.
The Prime Minister: The hon. Gentleman is absolutely right. We have got to be prepared to say that this was wrong and completely unjustifiable, and do what we can to repair at least some of the damage done.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): May I congratulate the Prime Minister on his apology today and congratulate the Child Migrants Trust? Many of these children not only lost their childhood and education, but worked as virtual slaves in Australia. Today's apology will be a small compensation for that terrible loss and experience. However, will my right hon. Friend guarantee that those surviving child migrants will not have to return cap in hand to the Government in a few years?
The Prime Minister: I hope that we will be able to continue the funding for as long as it is necessary to ensure that what reparation can be made, is made, and what damage can be reversed, is reversed. I know that we are dealing with the individual circumstances and stories of families now in very different positions, but we will do whatever we can to help individual families.
Dr. William McCrea (South Antrim) (DUP): I welcome the Prime Minister's statement and would like to associate my colleagues with it. It is a shameful part of our history, and we ought to make the apology with deep humility. Can he assure the House that the Government action of which he is speaking will extend to every part of the United Kingdom?
The Prime Minister:
Yes, I can. I thank the hon. Gentleman, because every party in the House has now associated itself with the apology. I believe that I can now tell the child migrants when I meet them that it is
the unanimous wish of the House both to apologise and to set up a new fund to help them.
Mark Durkan (Foyle) (SDLP): May I commend the Prime Minister's sincere apology and those from other party leaders in the House? They rang so poignantly with the very profound statement from Kevin Rudd last year. The Prime Minister will be aware that it was not just those children who were transported who suffered isolation, abuse and lies; many of their siblings left at home all too often experienced cruel care as well. Recently, many of them have come forward and had difficulty being received and believed. Their difficulty now is believing what they are being told: that there are no records available to settle their concerns, suspicions or beliefs that they have siblings in Australia and elsewhere. Will he ensure that this fund will help to unlock those difficulties that many of those people are now facing?
The Prime Minister: The fund is intended to help those families who were split up as a result of misguided decisions. Obviously, we shall look at what we can do to help reunite brothers and sisters or siblings, and at the same time ensure that they have proper provision for themselves in the future.
Sir Menzies Campbell (North-East Fife) (LD): Is it not clear, from what the Prime Minister has said, that one of the most reprehensible features of this policy was the systematic deception of children and their parents? Do we need any further indication of just how unreasonable this policy was other than the fact that it had to be cloaked in such deception?
The Prime Minister: First, the deception was unacceptable, but secondly the results of that deception were that parents thought that their children were in this country, when they were not, and children thought that their parents were dead, when they were alive. It is a most cruel deception for children to be made to believe that something that they should know about, or have the chance to know about, could never be told to them. When dates, birthdays and names are changed to conceal the truth, it is completely reprehensible, as the right hon. and learned Gentleman said in his eloquent way. We must make this apology, not just for that reason, but for the other reasons that I have cited.
Mid Staffordshire NHS Foundation Trust
12.58 pm
The Secretary of State for Health (Andy Burnham): With permission, Mr Speaker, I wish to make a statement on the report of the independent inquiry into the Mid Staffordshire NHS Foundation Trust, which I am publishing today. Copies have been placed in the Vote Office.
In July last year, I commissioned Robert Francis QC to conduct this inquiry. I asked him to establish what went wrong at Stafford hospital and why; what lessons can be learned; and what further action is needed to ensure the trust is delivering a sustainably good service to its local population. In particular, I asked his inquiry to focus on listening to patients and their families. I said at the time that the full impact of what happened at Stafford hospital would be understood-particularly in the NHS at local and national level-only when we heard clearly the voices and experiences of those most affected.
The Francis report fulfils all those aims. I wish to thank Robert Francis for his thorough report, and the painstaking way in which he has conducted this investigation. Over 900 pages and two volumes, his report lays bare a dysfunctional organisation at every level and appalling failures of basic care over the period between 2005 and March 2009. The report confirms the severity of the then Healthcare Commission's assessment of the trust in March 2009. In his covering letter to me with the report, Robert Francis says:
"The overwhelming number of accounts given by those affected should surely put to rest the views, still harboured by some, that the Healthcare Commission's report painted an unfair picture of how the Trust was performing. There can no longer be any excuse for denying the enormity of what has occurred."
Let me be clear: the care provided was totally unacceptable and a fundamental breach of the values of the NHS. Since March last year the Government's first priority has been to help the trust to take immediate steps to improve patient safety, care standards and public confidence. Last July a new chair and chief executive were appointed and, with a new board and senior team, they are making progress, as confirmed by the Care Quality Commission's three and six-month reviews. However, as their local hospital hits the news again today, I appreciate that doubts about safety will be in the minds of people in Stafford. In advance of this statement, I therefore asked the Care Quality Commission for its latest assessment of both the Mid Staffs trust and the wider NHS. I will place a copy of its letter in the Library. The Care Quality Commission confirms that the trust is safe to provide services, although further improvements are still needed, and says that it does not believe that there is any other hospital in England with problems on the scale or of the magnitude seen at Mid Staffs.
There have been many calls for a full public inquiry into events at the trust and the wider regulatory system. When I came into this job I gave those calls very careful consideration. In particular, I spoke to the four Members whose constituencies are served by the trust. It was clear to me that a further process of inquiry was needed to establish the full picture and to help the healing process. However, I had to balance that with not distracting the trust from the overriding need to make immediate
improvements in patient care. It was that consideration which led me to establish the inquiry in the form that it has taken, rather than as a full public inquiry. I did not believe that a lengthy, adversarial inquiry would be in the best interests of health care in Staffordshire. The chairman was able to ask me for further powers if he felt they were needed, but he did not do so, and I believe that his report supports the approach that we have taken. He concludes:
"I am confident that many of the witnesses who have assisted the Inquiry by written or oral evidence would not have done so had the Inquiry been conducted in public."
More than 900 members of the public and 82 current and former members of staff contacted the inquiry directly or indirectly, and 113 witnesses gave oral evidence. That evidence revealed an organisation with a culture
"not conducive to providing good care for patients or a supportive working environment for staff".
The board did not consider patient complaints, clinical governance or quality at its meetings. Meetings were held in private, and Robert Francis describes the organisation as working in isolation from the wider NHS community and as having a closed culture. As he has said today, the board
"lost sight of its fundamental responsibility to provide safe care."
That dysfunctionality extended to the way targets were managed in the trust and the failure to put in place adequate staffing levels to provide safe patient care.
The management of the trust cut staffing to dangerously low levels, at one point leaving A and E with a third fewer nurses than were needed to provide safe care. A work force review in March 2008 disclosed that the trust needed to increase its nursing establishment by 120 whole-time equivalents. There was an intimidating and bullying management style. Among staff there were failures of professional standards and clinical leadership. Some staff were praised, but the report finds a "lack of compassion" and an "uncaring attitude" among others. Time and again throughout the report, there are unacceptable examples of poor care, neglect and disregard for patients' dignity. At times, as Robert Francis says, that could be described as rudeness, hostility or even abuse.
The trust has already taken disciplinary action to hold individuals to account. The trust and the professional regulatory bodies, the General Medical Council and the Nursing and Midwifery Council, are investigating a number of clinical staff potentially implicated by those events. Today I have written to the chairs of both bodies to ask them to consider the report in detail and work with the trust to determine whether further action is needed against any individuals. I have asked for their response by 12 March.
In total, Robert Francis makes 18 recommendations. Together with the new board of the trust, the Government accept all the recommendations in full. I will take the four recommendations that apply to my Department in turn.
First, Robert Francis recommends that I consider steps to improve accountability among executive and non-executive directors of trusts. The board that presided over the failings at Mid Staffs has been replaced, and other managerial staff have been suspended. However, it is a long-standing anomaly in the NHS that the robust professional regulatory system for clinicians is
not matched by a similar scheme for managers and non-executive directors. We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere. That is not acceptable to the public and not conducive to promoting accountability and high professional standards, so today I am announcing that I will consult on a new system of professional accreditation for senior NHS managers.
Secondly, Robert Francis asks me to consider asking Monitor to de-authorise Mid Staffs as a foundation trust. The report makes it clear that Mid Staffordshire has not been deserving of the foundation trust status that it has held for the past two years. At the same time as setting up the inquiry, I proposed to create a new power for Monitor to de-authorise foundation trusts, to make it clear that this status has to be continually earned and is not a one-way ticket. That provision was subsequently endorsed by this House. I can tell the House today that I accept Robert Francis's recommendation to consider asking Monitor to de-authorise Mid Staffs. My strong view, in the light of the report and the support that the trust is likely to need in the medium and long term, is that I will ask Monitor to consider de-authorising when the powers come into effect in the coming months. I will therefore ask the CQC, Monitor and others to give me their views of the trust's long-term clinical and financial prospects, and I will consider initiating the process in the light of their responses.
Thirdly, Robert Francis asks me to review how comparative mortality statistics are compiled, as well as the methodologies that underpin them, to improve public confidence in and understanding of them. One of the principal reasons why the Healthcare Commission launched its review in 2008 was that it was not satisfied with the trust's explanation of its high hospital standardised mortality ratio. The inquiry has consulted a range of experts on the issue, and Robert Francis concludes:
"it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number or range of numbers of deaths were caused or contributed to by inadequate care".
However, as he points out, there is no shared methodology for HSMRs, nor any clear account of how they should be used and interpreted. The result is confusion for patients and the public. I therefore welcome and accept the recommendation to establish an independent working group to examine and report on the methodologies in use. The NHS medical director, Professor Sir Bruce Keogh, has already established that group, which includes the key parties involved in developing and using HSMRs, as well as leading academics and others. The group has committed to developing a single HSMR for the NHS.
Fourthly, the report calls for a further independent examination of all the commissioning, supervisory and regulatory bodies, in relation to their monitoring role at Stafford, with the objective of learning lessons about how failing hospitals are identified. I accept that recommendation, and can tell the House that Robert Francis has agreed to chair the further inquiry. We are publishing draft terms of reference today, and we welcome views on them.
In addition to accepting all the report's recommendations, there are further steps that I will now take to learn the lessons of this and prevent a repeat. First, let me make
clear today to all foundation trust boards my strong presumption that their meetings should be held in public and that governors should have access to all papers in the trust. The decision of the board at Mid Staffs to hold more meetings in private on achieving FT status is a direct contradiction of what this House intended when it passed the original foundation trust legislation.
Secondly, I am today accepting the National Quality Board's recommendations to improve early warning systems in the NHS, and I am publishing its report today. Thirdly, a group has been established to advise me on updating whistleblowing guidance. Statutory protection for whistleblowers is enshrined in the NHS constitution, but events at Stafford hospital reveal the need to ensure that staff feel able to exercise that right.
Fourthly, I want to see a much greater focus in the NHS on measuring patient satisfaction and staff satisfaction-key indicators of good quality care. In December, I announced that a growing proportion of a hospital's income will be linked to patient satisfaction, rising to 10 per cent. of its payments over time. Fifthly, I brought forward the new system of provider registration in the NHS to ensure essential levels of safety and quality. The CQC has already announced today its intention to register Mid Staffs, although it will place conditions where further improvement is needed.
In conclusion, the Francis report delivers a damning verdict on a dysfunctional organisation. It was principally a local failure, but I accept that there are national lessons to be learned-and they will be. Last year, the Prime Minister apologised to the people of Staffordshire. On behalf of the Government and the NHS, I repeat that apology again today. They were badly let down. I pay tribute to the people who had the courage to come forward and tell their stories and to expose the failures of the past, in order that they could protect others in the future. Robert Francis said that many of the patients who gave evidence to the inquiry
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