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The Prime Minister: That is a question that I am rather used to anticipating from those on the Conservative Benches. I think that even the most enthusiastic supporter of the European Union would recognise that the common fisheries policy has not been a success either in supporting our fishermen or in saving fish stocks. There are good lessons to be learned from other countries that have done better. I have to say though that that sometimes means some very drastic action in terms of closing some fishing areas altogether, but other countries have managed to do that and to regenerate their fishing stocks, so we will certainly take forward those negotiations on, I am sure, a coalition-wide basis.
Claire Perry (Devizes) (Con): Does the Prime Minister agree that we have heard a lot about fairness from Labour Members today, but there is nothing fair about the legacy that the Labour Government have left us: the £75 billion of debt interest that we will have to pay, which we could have spent on public services in all the constituencies represented in the House, including my constituency of Devizes?
The Prime Minister: My hon. Friend makes an extremely good point, which is that, if we do not take action to deal with the deficit, we will pay over £70 billion, not repaying the debt, but just on debt interest in five years' time. Think about it like this: all the revenue gleaned from corporation tax-all the tax on every company making a profit in our country-does not even pay for half the debt interest bill. That is the mess that we have been left in, but this Government have the courage to deal with it.
Q9.  Mr Frank Roy (Motherwell and Wishaw) (Lab): The Prime Minister will agree that cross-border rail services are strategically important to the UK. Will he therefore honour the assurances given to me by the previous Government that east coast main line services will continue to stop at Motherwell and that there will be an increase in west coast main line services stopping at Motherwell?
The Prime Minister:
I am grateful to the hon. Gentleman for raising that issue. I will certainly look at it. I cannot
promise to arrange all the stops on the east coast main line. Sadly, that is a power I do not think I have, but I will do my best.
Q10.  Nadhim Zahawi (Stratford-on-Avon) (Con): The Prime Minister will know that I am a follower of my beloved England football team. I ask him to do a great thing for the people of England: cut through the bureaucracy and nonsense and fly the flag of England over Downing street for the duration of the World cup.
The Prime Minister: I am pleased to tell my hon. Friend that I have had those conversations. There was some question that this was going to have a cost impact, but I have managed to cut through that and I can say that, at no additional cost to the taxpayer, the flag of St George will fly above Downing street during the World cup. I am sure that the whole House will want to wish Fabio Capello and all our team well-for the purposes of this, I am looking at all the Benches here. I am sure that everyone in the House, no matter what part of the UK they come from, will be cheering, "Come on England."
Q13.  John Woodcock (Barrow and Furness) (Lab/Co-op): I thank the Prime Minister for his kind words about the Cumbrian people. Can he say, in relation to his forthcoming gun review, whether he thinks that it is still worth the risk to allow guns used for sport to continue to be kept at home? Will that be considered in his review?
The Prime Minister: The hon. Gentleman is right that everything has to be considered, including the mental health of people and police visits to their homes, but we have, because of previous tragedies, very strict rules on what people who keep guns at home have to do in terms of very strict security. I remember sitting on the Home Affairs Committee and asking the ACPO representative responsible for the issue how much leakage there was from legally held guns into the illegal, black market. The answer was virtually none, so if we are looking for what the problem is, it is clearly that in our society we have a huge number of guns that we need to get rid of. Clearly, there was an appalling problem in this case, where, as I have said, a switch flicked in someone's head. We cannot legislate against that, but let us look at every aspect and ensure that we have the robust laws that we need.
In March last year, the Healthcare Commission's report on Mid Staffordshire and the appalling failures in patient care that it laid bare shocked us all. Three reports later, and I am announcing today what should have been announced then: a full public inquiry into how these events went undetected and unchallenged for so long. The inquiry will be held in public, including the evidence, the oral hearings and the final report. We can combat a culture of secrecy and restore public confidence only by ensuring the fullest openness and transparency in any investigation.
So why another inquiry? We know only too well every harrowing detail of what happened at Mid Staffordshire and the failings of the trust, but we are still little closer to understanding how that was allowed to happen by the wider system. The families of those patients who suffered so dreadfully deserve to know, and so too does every NHS patient in this country.
This was a failure of the trust first and foremost, but it was also a national failure of the regulatory and supervisory system, which should have secured the quality and safety of patient care. Why did it have to take a determined group of families to expose those failings and campaign tirelessly for answers? I pay tribute again to the work of Julie Bailey and Cure the NHS, rightly supported by Members in this House.
Why did the primary care trust and strategic health authority not see what was happening and intervene earlier? How was the trust able to gain foundation status while clinical standards were so poor? Why did the regulatory bodies not act sooner to investigate a trust whose mortality rates had been significantly higher than the average since 2003 and whose record in dealing with serious complaints was so poor? The public deserve answers.
The previous reports are clear that the following existed: a culture of fear in which staff did not feel able to report concerns; a culture of secrecy in which the trust board shut itself off from what was happening in its hospital and ignored its patients; and a culture of bullying, which prevented people from doing their jobs properly. Yet how these conditions developed has not been satisfactorily addressed. The 800-page report by Robert Francis QC, published in February, gave us a forensic account of the local failures in that hospital and the consequences for patients, but, like its predecessors, his report was limited by its narrow terms of reference.
I am pleased to say that Robert Francis has agreed to chair the new inquiry, and he will have the full statutory force of the Inquiries Act 2005 to compel witnesses to attend and speak under oath. Clearly these are complex issues, and Robert Francis has already said he wants to establish an expert panel that can help support him through this process. However, it is important for everyone that the inquiry be conducted thoroughly and swiftly, with the aim of providing its final report and conclusions by March 2011.
I also want to assure the House, however, that we will not wait to take earlier action where necessary. I can therefore announce today that we are going to give teeth
to the current safeguards for whistleblowers in the Public Interest Disclosure Act 1998 by: reinforcing the NHS constitution to make clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing; seeking through negotiations with NHS trade unions to amend terms and conditions of service for NHS staff to include a contractual right to raise concerns in the public interest; issuing unequivocal guidance to NHS organisations that all their contracts of employment should cover staff whistleblowing rights; issuing new guidance to the NHS about supporting and taking action on concerns raised by staff in the public interest; and exploring with NHS staff further measures to provide a safe and independent authority to which they can turn when their own organisation is not listening or acting on concerns.
In the coming weeks we will introduce further far-reaching reforms of the NHS that go to the very heart of the failures at Mid Staffs. This is not about changes in processes or structures; it is about a wider shift in culture, putting patients at the heart of the NHS and focusing on the things that matter most to them. That includes putting the focus on safety. At Mid-Staffs, safety was not the priority. It was undermined by politically motivated process targets. The first Francis inquiry was crystal clear on that point. It said:
"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."
We will scrap such process targets and replace them with a new focus on patients' outcomes-the only outcomes that matter. We will empower patients with access to information, giving them the ability to hold their own records, to make informed choices and to interact more readily with clinicians. We will put power in patients' hands. Ultimately, if patients had been informed and empowered, and if people had listened to them rather than obsessing about centrally mandated processes and targets, these scandalous failings could not have gone unchallenged for so long.
In closing, I want to say a word about the trust itself. It is so important that the hospital and the trust, which have been under such an intense spotlight, should be able to continue to improve services for the patients they serve and continue to rebuild the trust and the fractured confidence of their community. Staffing there has increased, with more than 140 more nurses recruited since March 2009. Processes are more open and transparent, and monthly board meetings are now being held in public. Results are improving: the hospital standardised mortality ratio there is now significantly lower, and the rate of healthcare associated infections has improved. The Care Quality Commission will, in the coming weeks, provide its considered view on that progress, when it publishes the findings of its "12 month on" review.
We cannot and should not underestimate the task still ahead, and the attention of the trust must not be unduly diverted. That is why I am clear that this further inquiry should not cover ground already covered in the first Francis inquiry, and that it should, as far as possible, ensure that it supports all those staff who are working so hard to bring about the necessary changes. When this inquiry has completed its work and I return to the
House to present its report, I am confident that we will, for the first time in this tragic saga, be able to discuss conclusions rather than just questions. We will be able to show that we have finally faced up to the truths of this terrible episode and that we are taking every step to ensure that it is never allowed to happen again. That is a basic duty of any Government. For the people of Staffordshire-many of whose relatives suffered unbearably in the closing stages of their lives-and for the nation as a whole, this is the very least they are entitled to. I commend this statement to the House.
Andy Burnham (Leigh) (Lab): I begin by thanking the Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley) for his statement, much of which I welcome. It will be hard for the people of Stafford and for the staff at the hospital to hear that their town and their hospital are in the news again today, and it is important to say at the outset-as the Secretary of State did-that this inquiry relates to historical events at the hospital and that the situation there has been improving ever since. I should like to put on record my own personal appreciation of the role played by the new chair and chief executive of Mid Staffordshire NHS Foundation Trust in improving standards at the hospital, rebuilding confidence and rebuilding the important relationships with the local community.
Events at the hospital between 2006 and 2008 represent one of the darkest chapters in our national health service. As the Francis report-which ran to two volumes and more than 900 pages-documented, there were appalling failures at every level, from basic care and human compassion on the wards to a failure in the duty of care at board level towards staff, patients and the whole community.
The NHS and its values are part of what makes our country great, but the NHS is not perfect. When things go wrong, it has a tendency to push people away and bring down the shutters. Yes, it is hard to deal with complaints when they affect matters of life and death, but it is only by holding up a mirror to the national health service that we will get an open, learning health service that learns from its mistakes and ensures that they are not repeated. That is why I took the decision to commission the original Francis report. It is also why, before the election, I signalled the need for a second-stage inquiry, to be held in public, into the actions of the supervisory and regulatory bodies, right up to the Department of Health. I therefore give the Secretary of State the assurance that this new inquiry will have the Opposition's full co-operation, from the very top right the way down.
We published the draft terms of reference for that second-stage inquiry before the election. Will the Secretary of State therefore explain to the House what questions or areas it will consider that were not covered either by the Francis report or the draft terms of reference that we laid before this House and on which we sought comments from a wide range of organisations? Also, what is different about the inquiry that he has announced, compared with the one that we proposed?
How long will the new inquiry take, and how much will it cost? Will he give the House an assurance-as I think that he did in his statement-that he will ensure
that it does not distract the trust from the overriding task of ensuring that the hospital continues to make the necessary improvements? Will he also make sure that the trust's leadership can continue to focus on improving relations with the local community?
Will the right hon. Gentleman give me an assurance that the recommendations of the original Francis report will continue to be implemented in full while the new inquiry takes place? He will know that Robert Francis concluded in his original report that many people came forward who would not have done if the inquiry had been held under a different status. I gave Robert Francis the ability to come back to me to ask for further powers if they were necessary, but may I ask for the right hon. Gentleman's assurance today that the status of the new inquiry will ensure that all the people who need to speak to it do come forward and give evidence?
On NHS targets, I was disappointed by the Secretary of State's comments in his statement, and by those of the Prime Minister a few moments ago, as they appear to be prejudging the inquiry that they have set up today. Trusts up and down the country are implementing national standards safely. Indeed, targets are about patient safety: the four-hour A and E target is the basic minimum that every person in this country can expect when arriving at the door of the NHS.
The targets were implemented and brought in because some years ago, people were waiting for hours on end-almost whole days-in A and E departments. If the Secretary of State is resolved to remove that standard in the NHS, which many of the professional health bodies support, will he therefore give us an assurance that we will not see a rise in A and E waiting times? What mechanism will he implement to ensure that?
The trust's board allowed staffing to fall to dangerously low levels, with 120 whole-time equivalents lacking from the wards. I put it to the Secretary of State that that was the main reason for the failures at the trust. I am sure that he will agree with me that not all the staff then working at the hospital are to blame, and that there are many good, decent, hard-working people at the hospital who will again find it hard to see their place of work back in the news today. There will also be many staff across the NHS who will feel that there is a daily focus on their failings but very little recognition of the outstanding professional standards that they show, or of the millions of acts of human kindness that take place in our NHS day in and day out.
In closing, may I ask the Secretary of State to give the House an assurance that he will always present a balanced picture and, in this case, be clear that these were isolated events at an isolated hospital?
Mr Lansley: I am grateful to the right hon. Gentleman for indicating that he supports this further inquiry, and that he and his colleagues will give it that support. They will know that for more than six years as shadow Secretary of State I always gave both a balanced and positive view of what the staff of the NHS achieve daily on our behalf. That extends to the staff at Stafford hospital, as I have made clear to them when I have visited them in the past. Indeed, I shall be visiting again tomorrow in order to make that even clearer-and I have asked Robert Francis to ensure that as he conducts his inquiry, he does whatever he can not to divert them from continuing to improve care for people in Staffordshire.
The right hon. Gentleman asked what the difference is between the inquiry that I am announcing today and what he said should happen in a second stage Francis report, and I must tell him that there are a number of very serious differences. First, this is an inquiry not under the National Health Service Act 2006 but under the Inquiries Act 2005, so there will be a presumption that hearings will be held in public, and that records of evidence and information given to the inquiry must be made available to the public.
In addition, there will be a power of compulsion in respect of witnesses and evidence. I simply do not accept his assertion that had there been a different legal basis for the earlier inquiry people would not have come forward to give evidence. Either they would have done so or, if they had not been willing to do so, they could have been compelled to do so; that power will be available now. This inquiry will have a power to take evidence on oath and a power under the 2005 Act to make recommendations, if Robert Francis so concludes, concerning not only NHS organisations, which are covered by the 2006 Act, but non-NHS organisations. The terms of reference make it clear that Robert Francis will be able to look more widely. The inquiry will examine, for example, the actions of the coroner and the Health and Safety Executive. Indeed, he will be able to make recommendations in relation to the General Medical Council. He would not have been empowered to do that in an inquiry simply under the 2006 Act.
Finally, may I deal with the right hon. Gentleman's point about targets? The four-hour target is not a measure of outcome; it is not a measure of the result for patients. The result for patients is about their going to an emergency department and their disease, injury or illness being treated successfully. What happened at Stafford hospital provided evidence-we saw other such evidence in many other places-to suggest that the four-hour target was being pursued not in order to give the best possible care to patients, but in spite of what would be the best possible care for patients. Patients were being discharged when they should not have been, and patients were being transferred to inappropriate wards where there was no provision to look after them.
It is vital that we focus on the result for patients. Like me, the right hon. Gentleman knows that the length of wait in the emergency department is not an irrelevant fact for patients. We are therefore going to consider, constructively, how to scrap the four-hour target as it currently exists, and, as my right hon. Friend the Prime Minister said at Prime Minister's questions, work on the basis of saying that what the clinical evidence makes clear directly contributes to delivering the best possible results for patients. We will start that process soon, in making that clear to the NHS. Our approach will go beyond the simple question of how long people wait in an emergency department; it will go to the outcomes being achieved in those departments. That is what putting quality at the heart of the NHS actually means; it means quality and results, not just processes.
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