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24 Feb 2010 : Column 319

My right hon. Friend said that more groups were being formed to examine a number of issues, including whistleblowing. May I ask him to look again at the recommendations in the Health Committee's report on patient safety? We suggested that there should be a system of whistleblowing like the one in New Zealand, which seems to be far more efficient and provide people with far more access. As my right hon. Friend pointed out in his statement, people in the NHS do not feel that they are able to blow whistles in an appropriate manner, even when there are horror stories such as those about what was happening to patients in Stafford hospital.

Andy Burnham: The Chair of the Health Committee has made a fundamentally important point, and he is right to press me on this issue. I believe that at times there is a failure at local level in the NHS to exercise the openness and transparency for which the House of Commons regularly calls.

I recall the debates on the foundation trust legislation. At the heart of that proposal was the replacement of national accountability with a greater degree of local accountability. It is impossible to say that that fundamental founding vision of what it meant to be a foundation trust was fulfilled in the Mid Staffordshire trust, and the issue of whistleblowing is an important aspect of that.

I do not believe that there is any Member in any part of the House who does not believe in the principle of whistleblowing. I do not believe that any of us would tolerate in our constituencies circumstances in which staff did not feel that they could come forward. We would want any member of the NHS to feel able and free to bring to our surgeries concerns about the trust in which he or she works. I believe that that goes for every Member of this House: no one who does this job wants to push away problems rather than addressing them directly.

We have put that requirement in the NHS constitution, and I repeat it today on the Floor of the House. We fundamentally uphold the right of NHS staff to raise concerns, and if their local trust does not have a culture that supports that, the position must be changed.

Several hon. Members rose -

Mr. Deputy Speaker (Sir Michael Lord): Order. These are extremely important matters. Let me repeat Mr. Speaker's earlier remarks. If I am to call every Member who wishes to ask a question, I must urge Members to ask brief questions and the Secretary of State-please-to give one brief answer.

Mr. William Cash (Stone) (Con): As the Secretary of State knows, from day one I have called for a full public inquiry under the Inquiries Act 2005, and I am glad that that request has been reiterated from my party's Front Bench today. Does the Secretary of State accept that many people feel that they did not obtain full justice from the report? The inquiry was held in private; furthermore, the very fact that the Secretary of State has arranged a further report from the same QC indicates that there should have been a full public inquiry in the first place.

Does the Secretary of State agree that the self-assessment question-the issue of the emphasis placed by the people in the regulatory system on targets and money-driven
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rather than patient-focused care-is the key question that must be looked into in relation to Stafford, and that in order to get that right-

Mr. Deputy Speaker: Order. I think that the hon. Gentleman has had his money's worth.

Andy Burnham: And he deserves to do so, Mr. Deputy Speaker. I am grateful to him for the role that he has played in bringing his concerns to me and to the Minister of State, and for the discussions that we have had.

The hon. Gentleman asked about "full justice". As the Prime Minister said earlier, individuals can make their complaints directly through a process of investigation. As for the fundamental question of whether it was right to hold a private inquiry, I have two points to make. I have to balance the need to ensure that the hon. Gentleman's local trust takes immediate steps to improve the quality of care that it provides for his constituents. I see that as my fundamental duty: above all else, I must help people today in the quality of care they receive. I accept that others may not agree, but it was my judgment that an inquiry of this nature was more likely to get to the bottom of the issues more quickly, so that the trust could focus on the job of improving patient care. I also refer the hon. Gentleman to Robert Francis's comment that he believed he received more from the public and staff because of the nature of this inquiry. The same level of privacy is clearly not justified in a national inquiry, however, which is why I say in the terms of reference that the presumption is that it should be conducted in public.

Charlotte Atkins (Staffordshire, Moorlands) (Lab): First, may I congratulate Cure the NHS on its work? I am delighted that the Secretary of State is determined to learn the lessons from Stafford so that the whole NHS can benefit. It is absolutely right that hospital trust boards must always meet in public. It is also right that the Mid Staffordshire NHS Foundation Trust should be de-authorised, but will the Secretary of State ensure that hospital managers do not profit from their failures and that other hospitals looking to apply for trust status, such as the University hospital of North Staffordshire, do not make the same mistakes as Stafford by putting financial issues and staffing levels before patient safety?

Andy Burnham: May I echo my hon. Friend's comments about Cure the NHS? Although this process is, of course, very difficult for all those affected at the local level, I can say without fear of contradiction today that the actions that it has taken are now leading to changes in the national health service that will prevent a repeat situation from arising either locally or elsewhere. A number of changes that will benefit patients everywhere have already been made.

I had to reread the passage in the report that stated that on receiving foundation trust status, the trust began holding more meetings in private, because that beggars belief. As anybody who debated the FT legislation knows, that fundamentally contradicts the vision for foundation trust status. I repeat to all foundation trusts today that we expect meetings to be held in public wherever possible. I also very much hear what my hon. Friend says about the importance of not jeopardising the quality of patient care. Patient safety is the paramount and overriding priority of every NHS hospital, and of every NHS organisation. Everything else comes second to that.

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Sir Patrick Cormack (South Staffordshire) (Con): In thanking the Secretary of State and the Minister of State, the right hon. and learned Member for North Warwickshire (Mr. O'Brien), for their unfailing courtesy in keeping Staffordshire Members informed, may I ask the Secretary of State to insist that the inquiry he has announced today be held in public, and to reflect upon the words of a widow who came to see me after having lost her husband, probably unnecessarily: what is crucial is that confidence and trust in the trust must be restored now, so that the area and the people the trust serves can look upon it with confidence and trust?

Andy Burnham: I thank the hon. Gentleman again for the manner in which he has helped us address these issues; his courtesy is always appreciated. I entirely agree that confidence is the key issue. This is another difficult day for the hospital, but I believe that from today the trust can begin to move forward, because we have now inquired fully and in depth at the local level. I believe the trust is making progress under Antony Sumara and Sir Stephen Moss; that is reflected in the report and in the reports that I hear locally from Stafford, and we need to do everything we possibly can to support them. There are 140 extra staff at the trust, and it has received about £4.5 million from the West Midlands strategic health authority. Support is going into the trust, therefore. We are considering whether we should initiate a process of de-authorisation, but we would only do so because we may be able to get more support more quickly to the trust, in order to build the confidence that the hon. Gentleman rightly calls for.

Dr. Tony Wright (Cannock Chase) (Lab): Even after four inquiries, it is still impossible not to be shocked by the record of failure of care in this case. We now know, beyond peradventure, what happened, and I think we know why it happened. What we do not yet know enough about is how it could have been allowed to happen. That is why there is a valid case for a fifth inquiry, into the regulatory structure, and I am glad the Secretary of State has announced that today. May I make one further point? There is one group of people who bear no responsibility for what happened: the patients. If we have one overriding obligation now, it is to make sure both that that hospital, which has failed them, pays for the errors of the past by being supported by the national health service, and that patient care in that hospital is as safe and effective as possible.

Andy Burnham: I entirely agree. My hon. Friend is right that there have been earlier inquiries, and I commissioned this extra report in order to hear loud and clear the voices of his constituents and those of other hon. Members who have spoken, and of my hon. Friend the Member for Stafford (Mr. Kidney), the Under-Secretary of State for Energy and Climate Change. The report is a thoroughly depressing read. When we hear and read stories of how patients were treated-and of patients doing their all to help staff, such as by taking the linen home to wash it-we know that there has been a basic failure of care for the constituents of my hon. Friend and of other Members, and there must be the most thorough investigation of that at local and national level. That is what I believe I am delivering to my hon. Friend and other colleagues in this House, and to their constituents. In the Francis report today, I
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believe we have the most thorough local investigation, and that will be followed by the second-stage inquiry, conducted in public wherever possible, so that we can get absolutely to the bottom of these issues, and people can finally feel that the issues they have raised have been fully investigated.

Dr. Richard Taylor (Wyre Forest) (Ind): As a member of the medical profession, I was staggered and saddened by the low profile and lack of effectiveness of staff whistleblowers in Stafford. I therefore welcome the Secretary of State's promise to update whistleblowers guidance. The Public Interest Disclosure Act 1998 and the work of Public Concern at Work need far more publicity. Does the Secretary of State agree that we still need to consider extra measures to support whistleblowers, who are still terrified of going through the normal channels? That is the whole point of my private Member's Bill.

Andy Burnham: May I say to my hon. Friend that my door is open to him to talk about his Bill and how we can deliver what we both want, which is to improve the culture in the NHS so that whistleblowers can come forward without fear of repercussions and recriminations? I cannot say today that that culture exists in all parts of the NHS, but I can say unequivocally that that is the culture I want to see in every corner of our national health service. If he is willing to work with me towards achieving that, I am sure that we have a completely common purpose.

Mr. Geoffrey Robinson (Coventry, North-West) (Lab): May I put a very simple point to my right hon. Friend? What clearly stands out from all this wealth of erudite and important words that we have heard in this House and everywhere else is that the hospital was terribly understaffed. If a company or any other organisation were so seriously understaffed, it would never get anywhere. I therefore have a suggestion. It involves one piece of paper, and I ask him not to resist it on that ground. In fact, such a piece of paper might already exist but have insufficient prominence. If we had one piece of paper on which hospitals had to list current staffing levels against the agreed requirement in the critical matter of doctors and nurses, we would all know whether or not there were sufficient staff to do the job. If such a piece of paper had been available, we could have avoided this whole situation.

Andy Burnham: I agree with my hon. Friend that that is, in many ways, the main message that comes out of the report. I was shocked to read that the work force review of March 2008 found a shortage of 120 whole-time equivalents, as well as one consultant in A and E when there should have been four, and 37 nurses when there should have been 55. Herein lie many of the problems the trust faced. It simply had an inadequate work force to deal with what needed to be done on a daily basis. That led to intolerable pressure on the wards, which in turn led to unacceptable treatment of patients. It is absolutely clear to me that this is unacceptable. That is one of the main messages that comes out of the report-and indeed, Robert Francis describes the trust as chronically understaffed.

Mr. Peter Bone (Wellingborough) (Con): The Secretary of State has said that one of his priorities is an early-warning system to ensure that what happened at Mid Staffs is not repeated elsewhere. The Dr Foster report identified
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seven hospitals with consistently high mortality rates. Is the Secretary of State going to order an investigation into those hospitals to make sure that their management is not leading to a possible repeat of what occurred at Mid Staffs?

Andy Burnham: The hon. Gentleman will know that action has been taken in respect of Basildon and Thurrock University Hospitals NHS Foundation Trust. He may not be aware that further steps are being taken against Tameside Hospital NHS Foundation Trust in Greater Manchester. Where action needs to be taken in order to intervene, we are taking that action. I should repeat to him the view of the Care Quality Commission, which is that there is no evidence to suggest that problems of this magnitude are replicated elsewhere in the NHS. I also say to him that I am not complacent on these issues: how could one ever be? Since what happened in Bristol, we can say with some confidence that we have, with the support of those on the Opposition Benches, begun a process whereby we are shining a spotlight on data in the NHS that in times past simply were not available. A wealth of data are now available to inform the public about standards at any particular trust. Many of the data are available on the NHS Choices website, but they can be improved so as to build a better understanding and appreciation of the picture at any trust. The hospital standardised mortality ratio-the HSMR-is not, in and of itself, a verdict on a trust; it is a trigger in respect of whether further action is required. As we have said today, we need further understanding of that target and an improvement of its methodology so that it is clearly understood across the NHS.

Frank Dobson (Holborn and St. Pancras) (Lab): I welcome the Secretary of State's commitment to hold a further inquiry into the regulatory bodies, in particular Monitor. He is talking about asking Monitor to de-designate the trust as a foundation trust, but a more fundamental question is how the hell Monitor ever came to designate it as a foundation trust in the first place, in the middle of this scandal. That was a lamentable performance by Monitor, which was supposed to look into all aspects of the situation and then make a recommendation to the Secretary of State. It seems that he can legitimately say that Monitor is not doing its job at all, and that some of the people at the top of Monitor ought to be leaving, under his new dispensation.

Andy Burnham: I thank my right hon. Friend for his question, and his welcome for the second stage inquiry under Robert Francis. The questions that he has just put before the House will be very much at the centre of that second stage investigation. The problem may have been that undue prominence was given to financial matters, rather than quality of care, when the foundation trust application was being considered. I say that without having had the further inquiry conducted, but those are precisely the matters that it will examine. I am grateful that my right hon. Friend supports the step that we are taking by carrying it out.

Mrs. Theresa Villiers (Chipping Barnet) (Con): If the Secretary of State cares about patients, will he ask NHS London to think again about its deeply misguided plans for reconfiguring health care services in north London?

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Andy Burnham: I do care about patient safety, and I say again that it is the overriding concern for every NHS organisation in the country, including NHS London. However, I would ask the hon. Lady to open her mind to the possibility that at times changes to hospital services are necessary to enhance standards of patient safety. The National Audit Office recently pushed Ministers on the reform of major trauma services, which implies a reconfiguration of hospital services. The lesson in the Mid Staffs case is that the trust was acting in isolation without sufficiently well developed clinical networks in its surrounding community. I say to the hon. Lady that sometimes patient safety may be enhanced, rather than diminished, by the reorganisation of services.

Mr. Gordon Prentice (Pendle) (Lab): May I return to the issue of HSMRs, which the Minister mentioned in his statement? He told us that there is no "clear account of how they should be used and interpreted. The result is confusion for patients and the public". He will know that people in east Lancashire are routinely told that the reconfiguration allegedly saved 200 lives. We know that academics and clinicians are reworking the methodology, but when will we get the results of that study, so that it can be applied across the NHS as a whole?

Andy Burnham: That is a very important piece of work, which is why I said in my statement that Professor Sir Bruce Keogh is already making progress on it. However, it is very important for the voices of the royal colleges, other professional bodies, and organisations across the health care world to be listened to in that work. When it is produced it will succeed only if it has support from, and is owned by, all those bodies. We will do this as quickly as we can, but in producing an HSMR measure in which the whole system has confidence we might need to take time to ensure that we carry out those discussions with all those concerned.

Mr. Brian Binley (Northampton, South) (Con): May I pursue the question put to the Minister by my hon. Friend the Member for Wellingborough (Mr. Bone) by asking him specifically about Kettering General Hospital NHS Foundation Trust, which was one of the seven on the list? Many people in Northamptonshire are unnerved by the possibilities that might arise from the situation in Kettering. I wonder whether the Minister will reassure them by saying what specific action he has taken with regard to that trust?

Andy Burnham: I would ask the hon. Gentleman to refer his constituents to the statement made by the Care Quality Commission today. I will place its letter, which gives assurances about the NHS as a whole, in the Library. I should say to him that there is a need for constant vigilance on safety standards in the NHS. The HSMRs are not, of themselves, evidence of failure-but they can provide a trigger for inquiry into whether standards are sufficiently high at any one hospital. I encourage him to continue to ask questions and to work with his local trust to ensure that standards are sufficiently robust at his local trust; that is exactly what I do with my local hospital. However, we need a better measurement of mortality ratios so that we can all be clear about, and have confidence in, what they tell us about our local hospitals.

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Point of Order

1.57 pm

Mr. Stephen O'Brien (Eddisbury) (Con): On a point of order, Mr. Deputy Speaker. I ask this while the Secretary of State is in his place, and with malnourishment being one of the many serious issues that arose at Mid Staffs. You will recall, Mr. Deputy Speaker, the answer given to me on 2 February 2010, at column 236W of Hansard, saying that the nutrition action plan, which the Government have been sitting on since as far back as last July, would be published "in February 2010." If that is to happen with a statement made to the House, it would need to happen tomorrow. Have you been given any indication that there will be an oral statement on that subject tomorrow?

Andy Burnham rose-

Mr. Deputy Speaker (Sir Michael Lord): I have no knowledge of the point that the hon. Gentleman makes, but I understand that the Secretary of State is anxious to say something.

Andy Burnham: Briefly, Mr. Deputy Speaker, tomorrow is dignity action day, and we will publish the nutrition action plan report tomorrow.

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