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"were motivated because they do care about the hospital, and demonstrated by their actions that they can be a part of mending the fractured confidence."
That sentiment is shared by all those who came forward, and indeed by the majority of people who complain about the NHS. They do so because they want it to be better. I want their voices to be heard loudly and clearly in this trust, and across the NHS.
Today, Sir David Nicholson has written to every NHS chief executive and chair, urging them to read this report and to review their standards, governance and performance in the light of it. When the NHS fails-as it did the people of Staffordshire-it is right to confront it with its failings. At times, there is a tendency in the NHS to push complaints away. I believe very strongly that it is only by facing up to failure-and by holding a mirror up to the NHS-that we can ensure that it is a learning organisation and prevent any repeat.
Since events at Stafford, Lord Darzi's next stage review has established a major drive to build an NHS that places a relentless focus on quality. For the vast majority of patients, the NHS provides a good standard of care. The CQC's latest patient survey showed that 93 per cent. of patients rated their overall care as good or excellent. When things go wrong, however, we must face up to them and do everything in our power to ensure that such events can never happen again. I commend this statement to the House.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to the Secretary of State for making an oral statement today, and for giving me advance sight of it. I want, once again, to express our deepest sympathies to the patients who suffered and to the relatives who saw them suffer. My right hon. Friend the Member for Witney (Mr. Cameron) and I have had occasion to talk to those relatives in Stafford, and the stories of their experiences were harrowing. Today's report, the second volume in particular, sets out the most compelling-indeed, horrific-character of many of the sufferings of the patients and their relatives.
I pay tribute to the work of Julie Bailey and Cure the NHS, and to their determination and persistence in holding the hospital trust and the Government to account for their failures in relation to this hospital, and in securing this further investigation. The Secretary of State will recall that, when the Healthcare Commission published its first report, his predecessor instituted an internal Department of Health inquiry under Dr. Colin-Thomé and another under Professor Sir George Alberti. We told the Government then that that would not meet the need of the people of Stafford for a clear investigation in public into what had happened. When the Secretary of State announced this inquiry by Robert Francis, we told him again that it would not achieve that aim. This is the fourth report, and none of them has diminished the need for a public inquiry under the Inquiries Act 2005, in which evidence can be taken in public and under oath. We can combat a culture of secrecy and bullying only by ensuring the fullest openness and transparency in any investigation.
The whole House will, none the less, be grateful to Robert Francis for fulfilling his brief in a thorough and objective manner. We find no fault with his work, but we do object to Ministers setting up report after report with constrained terms of reference that are designed more to focus on local management than to get to the full truth and the full context of the tragedy at Stafford hospital by analysing in addition the failure of national and regional scrutiny and of NHS performance management.
In my evidence to Robert Francis, I urged him to recommend a further investigation into the role of the external monitoring and performance management agencies, and I am glad that he has taken this advice and made that recommendation today. Such a further investigation is essential, because many of the serious questions that we and the relatives of those who died have been asking the Government for the past year remain unanswered.
Why did the primary care trust fail to ensure that standards were up to scratch when it commissioned services from the hospital? Why did the strategic health authority, which was charged with performance management of the hospital when it was an NHS trust, fail so abjectly in that task? Why did the Department of Health simply wave through the foundation trust application at the very time that clinical standards were so poor? Why did it take so long for the scrutiny by the inspectorate to establish that the high mortality rates were occurring, and to undertake an investigation into them? What are the problems with national policy and decision making on patient and public involvement that resulted in people failing to listen to patients raising their concerns in Stafford? And what are the problems with the
whistleblowing procedures and practices in the national health service that prevented or inhibited front-line staff from speaking out about poor standards of care?
The Francis report provides a powerful analysis of the impact of the Government's top-down targets on patient care at Stafford hospital. When the scandal was laid bare by the Healthcare Commission last March, the then Minister of State, the right hon. Member for Exeter (Mr. Bradshaw), said that
"this was not a problem about targets".
"This evidence satisfies me that there was an atmosphere in which front-line staff and managers were led to believe that if the targets were not met they would be in danger of losing their jobs. There was an atmosphere which led to decisions being made under pressure about patients, decisions that had nothing to do with patient welfare. As will be seen, the pressure to meet the waiting target was sometimes detrimental to good care in A&E."
Will the Secretary of State now acknowledge that Ministers were wrong to deny that targets were part of the problem at Stafford, and that they are wrong now to maintain that they are not the issue? Will he therefore move to abolish top-down political targets, so that the NHS can focus on patient safety and quality of care as an absolute priority?
In this Parliament alone, I have had to stand at this Dispatch Box on four occasions to respond to issues of failing hospitals: Stoke Mandeville in 2006; Maidstone in 2007; Mid Staffordshire last March, and again today; and Basildon and Thurrock in December. Each time, Ministers have insisted that these are isolated cases and blamed local management principally, but the themes have become too frequent and too familiar for this simply to be a coincidence: 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 putting targets and policy processes ahead of a focus on quality care for patients; primary care trusts focused on cost and volume, and not on quality; and front-line staff finding their attempts to voice concerns going unheard or, even worse, suppressed. That is not good enough. We cannot go on like this.
We must be committed to establishing a full public inquiry into the tragedy at Mid Staffs. It must be an inquiry with a remit broad enough to ensure that no stone remains unturned and no lesson is overlooked. That would restore confidence among the public in and around Stafford. We will learn the lessons across the NHS, and we must do so up to and including the Department of Health. Action must be taken on the results.
For our part, we would abolish top-down political targets and the pointless bureaucracy that surrounds them. Instead, we would focus relentlessly on the results for patients. We will make patient experience and outcomes central to accountability. We will ensure that the quality imperative drives NHS services so that when complaints are made, the inspectorate receives, understands and acts on them. We will make quality and safety the central drivers of NHS performance and we will see through the changes in leadership, strategy and reform in the NHS that will give the public the confidence that when they go to hospital, they are there to be cared for and to be treated-and never to be harmed.
Mr. Speaker: Order. This is an extremely important and sensitive matter. Nevertheless, both the Secretary of State's statement and the initial response from the shadow Secretary of State have exceeded the time allowed for such exchanges, so I would ask the Secretary of State to provide economical replies and for others to take note in order that we can all make some progress.
Andy Burnham: Thank you, Mr. Speaker. The shadow Health Secretary began by extending his deepest sympathies to the patients and families affected, and I am sure that that will be echoed across the whole House and across the country. Today is another difficult day for those people, but we hope that this report will allow their voices to be heard at least more clearly than they have been hitherto.
The hon. Gentleman paid tribute to the work of Cure the NHS, which campaigned to have the events at Stafford hospital thoroughly investigated, and I believe that the report published today meets that requirement for a thorough investigation into those events. He asked whether the initial inquiries were internal to the Department of Health and he called for an independent inquiry, but that is the inquiry that I commissioned. As I said in my statement, when I came to this Department, I believed that a further process of independent inquiry was necessary. I commissioned it; I set it up; and I will deal with what it tells me today.
I do not think it is possible to read the Francis report and conclude that it does not tell the full truth or reveal the whole picture of what happened at the hospital. We now move forward from the inquiry to consider the actions of the regulatory and supervisory bodies. I have made it clear to Robert Francis that, should he need further powers to conduct that part of his work, he can come back to me and I will consider the request.
"The Government's presumption is that the inquiry will be held in public, but this decision is a matter for the Chair."
The hon. Gentleman also asked about the PCT, the SHA and the Department of Health. He is quite right to do so: he is quite right to ask questions about those bodies, their role in what happened and why things were not spotted sooner. That is precisely why we are setting up the second stage of the inquiry-so that those searching questions can be asked of those organisations.
"As will be seen, the pressure to meet the waiting target was sometimes detrimental to good care in the organisation. This is inconsistent with the guidance about targets published by the Department of Health. It is vital that this target must not in any way jeopardise the quality of care offered to patients."
If the hon. Gentleman reads the Francis report in full, as I am sure he will, he will see that the failure of the trust was the implementation of targets within it, and, indeed, the failure to provide adequate staffing levels on the wards to ensure that care could be delivered safely and meet the standards that other trusts around the country are able to meet. That is the conclusion I draw from the inquiry.
The hon. Gentleman asked what steps we can take to ensure that this does not happen elsewhere in the NHS. With an organisation on the scale of the NHS, I am sure that he and I would accept that things will go wrong and problems will occur. The right thing to do is to face up to them and take action to prevent them from happening again. In this particular case, I believe that we have faced up to the enormity of what happened at the Mid Staffordshire NHS Foundation Trust. It has been laid bare today in a very detailed report of more than 900 pages. I can assure the hon. Gentleman that I take my responsibility to act on the report's findings with great seriousness. That is precisely what I will do.
Norman Lamb (North Norfolk) (LD): I thank the Secretary of State for early sight of his statement. This is an utterly shocking scandal, which is a stain on the good name of the NHS. It demonstrates again horrifying evidence of patient neglect, which should never feature in the national health service. I welcome the recognition in the statement that there are national lessons to be learned, but the focus of the inquiry was none the less on this particular trust.
It seems to me that the inquiry was not designed to ensure that the full wider lessons could be learned. It was not designed to hold anyone to account, which it specifically says, as the terms of reference did not permit investigation into the role of any of the external agencies. It was also held in private. The inquiry was not able to consider the reports of any of the individual cases through a separate process because they were not ready in time. The report itself confirms that disappointing numbers of staff came forward to give evidence. That is not good enough. It is not the fault of the inquiry, but the fault of the process created by the Government. The bottom line is that the report will not satisfy the families of those who lost their lives and it will not bring an end to demands for a full public inquiry. I also pay tribute to the work of Julie Bailey and the organisation Cure the NHS.
Do not the findings reinforce the need to learn wider lessons about the causes of the failures that took place in the hospital: the focus on process at the expense of outcomes; the failure to listen to those who receive care; staff disengaged from the process of management; insufficient attention to the maintenance of professional standards; a weak professional voice in management decisions; abuse of vulnerable elderly people; and a lack of transparency? The key point is that none of those findings can be said to be unique to this particular trust. The hon. Member for South Cambridgeshire (Mr. Lansley) highlighted other failing hospitals that the House has debated.
There is surely a need for a full public inquiry, and it should surely first consider the pay-off to the chief executive and the fact that people are too often rewarded for failure. This chief executive received £400,000. I have a copy of the private investigation into his actions. Surely it should be published in full-it is heavily redacted, which amounts to a cover-up of the full findings of the investigation. It points to a case for disciplinary action, yet there was a very substantial pay-off to this chief executive.
A public inquiry should also look at the role of targets. The statement rightly said that blaming targets in their entirety would let management off the hook,
but not looking at targets lets the Government off the hook, given that targets played a part in the failures of this hospital.
It is also essential to look fully at the role of regulation. I am pleased that there will be a further inquiry into that, but it should surely be held in public and should look at the complex web of regulation that we have created. The fact that we have five different national organisations with some responsibility for patient safety has resulted in no one taking proper responsibility for it. In Basildon, for example, there were 21 visits by seven different organisations in the year before the final report emerged. We need to look at the devastating report into the role and failure of regulation that was commissioned by the NHS Confederation last summer. It showed that we have ended up with paper safety rather than real patient safety and a tick-box culture.
A public inquiry should also look at the process for securing foundation trust status, which provided a false reassurance to people that the hospital was performing to a high standard. Finally, do we not owe it to the families of those who have lost their lives to have a full examination in public of the wider lessons that need to be learned from this scandal?
Andy Burnham: I agree with the hon. Gentleman that this is a shocking report that damages the name of the national health service. He asked why the report did not allow consideration of wider national issues, but he will have seen that the report does comment on national lessons to be learned. There were four recommendations in the report, which I spelled out in my statement, and I responded to those points. I did agree with the chairman that he could comment on what he wanted to comment on. However, we wanted the inquiry to focus primarily on the trust and the voices of the patients affected by the terrible events in the trust, so that we could get to the bottom of the failings and allow the trust to move on-which is, I believe, what we must do.
I wanted to get to the bottom of events as quickly as I practically could. I was also anxious that the trust should not be debilitated by a protracted inquiry that would divert it from its main job. I believe that we have got to the bottom of what happened locally; I now want the trust to move forward, and I believe that it is moving forward under the leadership of the new chair and chief executive. However, I accept Robert Francis's recommendation that we look more closely at the bodies that have a supervisory, regulatory and commissioning role in relation to Mid Staffordshire NHS Foundation Trust. As the hon. Gentleman will know, we have already embarked on that task. David Colin-Thomé has done some work in examining the role of the primary care trust, but we must now put that work on a proper footing-knowing what we know from the first inquiry-so that we can learn the lessons at a national level, and I can assure the hon. Gentleman today that that is what we will do.
The hon. Gentleman said that the failings were not unique to this particular trust, and rightly observed that what went wrong in this instance was caused by a focus on process rather than on people. The words "focus on process" were used by Robert Francis, and they are at the heart of what went wrong. There was a failure to understand and respond to the public about what matters,
and to see each patient as an individual deserving of the very highest standard of care-the care that we would all want our own families to receive.
The hon. Gentleman was right to say that the failings described in the report are not unique to the Mid Staffordshire NHS Foundation Trust, but it must also be said that the scale on which they occurred make the events in that trust unique. I sought an assurance from the Care Quality Commission that no other NHS trust exhibits problems on the scale of those found at Mid Staffordshire, and it gave me that assurance today, but let me also assure the hon. Gentleman that we remain constantly vigilant, and will ensure that every possible action is taken to deal with poor performance and poor quality in the NHS.
The hon. Gentleman asked about the Garland report on the former chief executive of the trust. I understand that he did not receive £400,000, but received his notice period and no more than his contractual entitlement.
The hon. Gentleman also asked about targets. The suggestion is that targets are there to distract people in the NHS from patient care, but they are essentially about the basic minimum that every person who arrives at the door of the NHS should be able to expect. They are fundamentally about people and the quality of care that should be given to every single person, regardless of their background or what they bring to the door of the NHS. In this case, the trust grotesquely failed to manage the pressure involved in delivering that basic standard of care to every person who arrives at the door of the NHS, which is what so many other trusts throughout the country manage to do.
Let me remind the hon. Gentleman what happened before there were targets for accident and emergency departments. The previous Government, in fact, suggested a four-hour target because there was chaos in A and E departments in the early and mid-1990s, and the present Government retained that target because basic minimum standards must be available to every patient who arrives at the door of an accident and emergency department.
The hon. Gentleman asked for a proper safety structure rather than "paper safety". I can tell him that I take my responsibilities in respect of the new registration process extremely seriously. He will know that I have expedited the introduction of that system, which I believe directly responds to the concern that he has expressed.
Finally, the hon. Gentleman asked for a full inquiry into all these events. I believe that the second inquiry that I am setting up today will meet his demands. I invite him to comment on the draft terms of reference, and if he believes that they can be strengthened, I shall listen to his comments.
Mr. Kevin Barron (Rother Valley) (Lab): I must tell my right hon. Friend that I am not surprised by the contents of the report-although I have not read it yet-in view of the evidence taken a few months ago by the Select Committee on Health about patient safety, part of which concerned the Mid Staffordshire NHS Foundation Trust. When we debate the subject in Westminster Hall next month, it will be possible to flesh out these matters a little further.
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