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Jeremy Lefroy (Stafford) (Con): I am most grateful to my right hon. Friend for his statement and for the announcement of an inquiry under the 2005 Act. I am also grateful to him and to the Prime Minister for their support for my constituents over the extremely difficult past year. The Secretary of State will recall that I have
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written to him on a number of matters in connection with this case, but I should like to raise just one now. Can he assure me that the resources needed both for the inquiry itself and for staff cover will be made available to the trust, so that staff can continue the vital work of restoring public confidence in Stafford hospital?

Mr Lansley: I am grateful to my hon. Friend for that question. Although he has only recently arrived in this House to represent his constituents, I know from my personal experience of our conversations, our meetings and my visits to see him and others in Stafford just how diligently and consistently, and in what a compelling way, he has represented his constituents over the past year or so. In reply to his question, I can tell him that although I have made it clear to Robert Francis that we must do this swiftly-and, therefore, without incurring excessive costs-we must do it successfully and achieve a quality result in order to inform everything we need to do to improve the NHS. We need to go beyond the mere structures and the processes-we have seen all that-to find out why people in all those structures were not focusing on patient safety and quality of care, and how they can be better incentivised, encouraged and required to do that in future. I am sure that my hon. Friend knows that we are ensuring that the additional costs that the Mid Staffordshire trust has had to meet in the course of the first Francis inquiry and now, and in supporting the delivery of better care, are being met with additional resources from the strategic health authority.

Joan Walley (Stoke-on-Trent North) (Lab): May I, on behalf of constituents whose families were affected by what happened at Mid Staffs, welcome the continued focus that the new coalition Government are placing on making progress on this issue and on ensuring that what happened before never happens again at Stafford hospital? I pay tribute to the work done by my former colleague David Kidney, who, along with the action group, called for a full public inquiry into this matter; that needs to be put on the record. Will the Secretary of State give me assurances about the make-up of the panel, and perhaps give consideration to making trade union representatives members of it? We need to ensure that all people affected in the provision of care can be properly represented and can be part of that panel in the further inquiry.

Mr Lansley: I am grateful to the hon. Lady for her support for the further inquiry. I should say, first, that I share her view that David Kidney sought to get to the bottom of what happened at his local hospital, and pressed for a further, and public, inquiry. The shadow Secretary of State must know that at the beginning of last September Robert Francis came to him in the midst of his first inquiry to raise the issue of the legal base for that inquiry and the question of whether it should be brought under the Inquiries Act. He wanted the terms of reference to be extended sufficiently widely to ensure that at that stage he could have looked beyond the question of what happened, to the question of why the primary care trust, the strategic health authority, the NHS in general, and other organisations, did not intervene earlier and in a better way. On 10 September last year, the then Secretary of State did not agree that that should happen, but had he done so the first Francis inquiry could have achieved much earlier what the second will now have to do.

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Mr William Cash (Stone) (Con): I thank the Secretary of State for his statement, which was well overdue because the previous Government declined to do what he has agreed to do. I also thank the Prime Minister-a former candidate for Stafford-who took a very active part in this extremely important decision, for which both my constituents and those in Stafford will be deeply grateful. The Secretary of State has rightly dealt with the question of oaths and of compulsion of witnesses. Will he also indicate that expenses relating to the provision of legal representation for witnesses will also be made available? In addition to dealing with issues relating to whistleblowers and targets, will the whole question of self-assessment by hospitals and hospital trusts be considered? Will the inquiry examine those matters? A similar inquiry in 1984 led to a great improvement in the national circumstances relating to hospitals. The same hospital was involved in the legionnaires disease inquiry that Baroness Thatcher incorporated. I again thank the Secretary of State for making this decision, which will be greatly welcomed in my constituency.

Mr Speaker: Although we heard about four questions there, I am sure that the Secretary of State will content himself with one reply.

Mr Lansley: If I may, Mr Speaker, I shall content myself with saying that my hon. Friend made it clear from the outset that an Inquiries Act inquiry was the right idea. He said that more than a year ago, and had we gone down that route then, we would have been much further towards getting to the whole truth now. Matters relating to the Inquiries Act and the panel membership are ones that will now be determined by Robert Francis. I have published the terms of reference to which he will be working, and under the Inquiries Act issues such as legal representation and its funding are determined under those.

Robert Flello (Stoke-on-Trent South) (Lab): My constituents who were affected will also be following very carefully what happens in this public inquiry, and I associate myself with what has been said about David Kidney, who worked extremely hard and effectively on this horrific issue.

I am concerned that the horrific failure at this hospital is being used as a hook in a most appalling way for the proposals to scrap targets, which the Conservatives have talked about for a long time. In any system there will always be people who try to manipulate it; in a culture of fear and bullying, as there was in this hospital, that is exactly when systems will be manipulated. Will the right hon. Gentleman therefore take into account as wide a spectrum of advice as possible when he is considering the new outcome proposals, to ensure that whatever system he brings in is not also open to abuse and manipulation?

Mr Lansley: One of the hon. Gentleman's friends says that we should take action on the basis of the first Francis inquiry, and we will, and the hon. Gentleman says that we should not take action on targets. The first Francis report made it clear that targets compromise patient care, so we do need to take action.

The hon. Gentleman asked a further question. Robert Francis and I have had two discussions and the terms of reference are very clear. He is looking beyond the structures and processes to how the culture of bullying, fear and
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secrecy came to pass, what effect it had and how we can move beyond that. The report will be very important, if it is successful, not just for the people of Staffordshire but right across the country in showing how we can move from a top-down, secretive, bullying culture to one that is absolutely open, transparent, focused on patient safety and entirely responsive to the needs of patients.

Mr Aidan Burley (Cannock Chase) (Con): One of the tragedies is that concerns were being raised about Stafford hospital as long as five years ago but little or no notice was taken of them. A constituent of mine, Barbara Allatt, was until recently a student nurse who helped to expose the appalling neglect of elderly patients at the hospital trust, but rather than her concerns being acted on, she was instead needlessly thrown off her training course. In his statement, the Secretary of State outlined new whistleblowing rights for future staff. Will those rights be extended retrospectively so that staff who spoke out previously, and in doing so put their job at risk, will not be punished again?

Mr Lansley: Of course, by definition, contractual rights cannot be retrospectively applied, but let me make it clear that I will be issuing guidance in terms that I have set out to the House in my statement today-albeit that we might need to do more. That guidance is entirely intended to move the NHS to an open culture that encourages staff to raise concerns. As I said to the Patients Association yesterday, we must have a culture of challenge inside the NHS under which the offence is not to make a mistake, as mistakes are human, but to seek to cover up or ignore a mistake. That is what happens in the best organisations and it must be what happens throughout the NHS.

Steve McCabe (Birmingham, Selly Oak) (Lab): I welcome the Secretary of State's promise of early action. Will he tell us how many members of the present board were in post on 18 March 2009 and when he will sack them as he has promised?

Mr Lansley: The hon. Gentleman will forgive me: I know that the chief executive, the chair, the nursing director and others have moved on, but I do not know the precise answer and I will write to him about that. In relation to any individuals, I think it is proper that, having asked Robert Francis to conduct a further inquiry that takes account of all that he discovered in the first report and that covers the same period of time-2005 to 2009-he is free to make recommendations that will bear upon people working inside the trust and in organisations, and upon how they discharge those responsibilities.

Gavin Williamson (South Staffordshire) (Con): I thank my right hon. Friend for announcing the inquiry, which will be welcomed by many of my constituents and others. I urge the Department of Health always to listen to the relatives of patients, because relatives were saying that this was a problem far earlier than anyone else. Will the Secretary of State, please, always listen to what relatives and patients say?

Mr Lansley: I am glad that my hon. Friend raises this point, because I know from the four occasions on which I have visited Stafford and talked to members of the
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Cure the NHS group just what a desperate struggle they had to be listened to. We should therefore be clear not only about changing the culture inside the NHS, so that patients' issues and complaints are treated seriously from the outset in an open and transparent way, but that the patient voice should be strengthened in the NHS. Even people who are literally self-appointed voices for patients should not be dismissed and pushed to the margins. We have to be prepared to listen to patients however their views are brought forward.

Mr Dave Watts (St Helens North) (Lab): The Secretary of State was unclear about his proposals for waiting times. Will he clarify this issue? He seems to be saying that he will do away with waiting times but then introduce a new system. Will the new waiting time be four hours, five hours, six hours, 10 hours or 12 hours?

Mr Lansley: I am afraid that the hon. Gentleman does not seem to understand. I was very clear in saying that I am going to abolish the four-hour accident and emergency target. I will issue guidance to the NHS shortly, the purpose of which is to amend the four-hour A and E target, alongside others, to ensure that we deliver better quality. That is not just about the time spent waiting in an emergency department; it is about the quality of the service provided and it is based on clinical evidence.

Andy Burnham: That is unclear.

Mr Lansley: The point that I am making is very clear. We are not going to focus on narrow process targets in future; we are going to look at the quality and outcomes provided for patients. I will issue future guidance on that.

Nadine Dorries (Mid Bedfordshire) (Con): The report highlights that there was a breakdown of care at almost every level, from basic nursing care up to high levels of communication. Does the Secretary of State agree that when the patient becomes the absolute focus of every level of care delivery, from basic levels of nursing care right up to top levels of management, it will be more difficult for such a culture to grow in terms of process delivery? Will he guarantee that the report will look at putting back into hospitals the approach of making the patient the most important person and of putting the patient at the centre of every element of care that is delivered?

Mr Lansley: Yes; my hon. Friend is absolutely right. That is why I have made it clear that that is the first priority for our Department in how we are going to improve the NHS. As a nurse, my hon. Friend will know that what she describes is absolutely how many people across the NHS want to conduct their professional relationships. They have been so frustrated, demoralised and demotivated by not being able to deliver care in the way that they wish-focusing on the needs and expectations of patients.

Mr Stephen Dorrell (Charnwood) (Con): Is not the important issue that the terrible events in Mid Staffordshire are not purely a local issue, terrible though they are for Mid Staffordshire? It is vital that lessons are learned for application right across the NHS. What were the commissioners doing? Where were the regulators? What price professional accountability? Why was all that allowed
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to happen over so long? Perhaps the most difficult question of all is this: why was it not the first time that this had happened in the NHS?

Mr Lansley: My right hon. Friend is absolutely right. That is why we have to move from all those questions to some serious answers-so that we can have the reform that the NHS so badly needs. I know and he knows that this is about not just a different set of structures, but a change of culture and a focus in the NHS on patients and results for patients to the exclusion of other bureaucratic impositions. There is such immense bureaucracy-PCTs, SHAs and regulators-that everything should have worked perfectly, but it did not. Why? Because in all of that, the underlying pressures in the service were not focused on results for patients. We have to drive towards that conclusion.

Siobhain McDonagh (Mitcham and Morden) (Lab): Will the Secretary of State give way?

Mr Speaker: There is no giving way involved; this is a statement.

Heather Wheeler (South Derbyshire) (Con): I welcome my right hon. Friend's statement. Only yesterday, I wrote to him regarding a constituent in South Derbyshire who had gone through a four-hour wait and was then admitted, to make sure that the four-hour rule was not broken, and had to stay in a ward for six hours and see even more people when he could have been on a bus going home much earlier. There are lessons to be learned across the whole country, and I look forward to the report coming through.

Mr Lansley: I am grateful to my hon. Friend. We will take not only the clear evidence from the first Francis report, but evidence from many other places, including that from many of the leading clinical professions that the way in which the four-hour target has been administered has undermined the quality of patient care. We will focus on quality and help the NHS to deliver what it knows is the right quality.

Harriett Baldwin (West Worcestershire) (Con): I welcome my right hon. Friend to his post and thank him for his two visits to Malvern over the past few years to support the new community hospital that will open in October.

My right hon. Friend mentioned the West Midlands strategic health authority. In the past six months, the authority has required our local Worcestershire NHS to divest itself of its community hospitals. At the moment, the authority is proposing to abolish the mental health trust and put it and the community hospitals into a new trust. Secondly, it has asked NHS Worcestershire to cluster with neighbouring NHS organisations. What are my right hon. Friend's proposals to stop all those reorganisations and focus on patient outcomes?

Mr Lansley: The inquiry will look at both the West Midlands SHA and its predecessor bodies. My hon. Friend will know from what I said a couple of weeks ago that proposals for such reconfigurations in the national health service must now answer to the clinical evidence-the clinical base. They must answer to patients-current and prospective patient choice-and to the referral intentions and commissioning intentions of general
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practitioners exercising responsibility for commissioning. That will change the nature of such decisions from a top-down, unaccountable process to one that is much more locally accountable and effective.

Mr Peter Bone (Wellingborough) (Con): The excellent new Secretary of State for Health was right to praise the men and women of the health service, but when things go wrong there needs to be an early-warning system. Does he agree that standardised mortality rates are an indication that something might be going wrong, and that such indicators should be used more often to investigate hospitals?

Mr Lansley: I am grateful to my hon. Friend. First, the Francis inquiry will go on to understand why one of those hospital SMRs, from 2003, indicated the nature of a potential problem. The SMRs are not a sufficient measure of quality across the board. The National Quality Board has already undertaken some work on how we can ensure that hospital SMRs are consistent and meaningful, and beyond that how we can identify the early-warning signs and act on them. As one of the things we derive from that, I shall be working with the quality board and across the NHS to ensure that we act on warning signs, including looking at potential risks either across the system or in relation to individual trusts.

Dr Sarah Wollaston (Totnes) (Con): Will the inquiry cover the sheer volume of bureaucratic paperwork that nursing staff have to complete, which seriously gets in the way of their fulfilling their clinical responsibilities?

Mr Lansley: I am grateful to my hon. Friend. The answer is yes.

Mr Speaker: I am grateful to Members for their co-operation. We have got to everybody.

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Point of Order

1.13 pm

John Healey (Wentworth and Dearne) (Lab): On a point of order, Mr Speaker. May I draw your attention to today's edition of The Daily Telegraph? It announces a planning policy change on so-called garden grabbing. May I ask you to investigate the circumstances of this case, which appear to be of selective leaking and spin, and will you report to the House your views on that and your views in general on announcements being made to journalists before they are made to Members of the House?

Mr Speaker: I am grateful to the right hon. Gentleman for his point of order. I hope he will not be shocked, and the House will not be horrified, to learn that I have not yet read The Daily Telegraph today. However, I am mindful of the fact that there has been a written ministerial statement on the subject by the Government, so I do not think it would be correct or accurate to characterise the situation as one in which the House has not been informed of Government policy. I am happy to look at the piece in question. I will reflect on it. If I have anything further to add that the House needs to hear, the House will hear it, but otherwise I am inclined to leave the matter there.

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