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The Minister of State, Department for Business, Enterprise and Regulatory Reform & Foreign and Commonwealth Office (Lord Davies of Abersoch): My Lords, we continue to consider industry proposals for a scrappage scheme. The proposals are potentially costly for the taxpayer, and we need to consider the costs and evidence on positive and negative impacts. We are also looking at the experiences of other countries that have introduced similar schemes, such as Germany.
Lord Razzall: My Lords, I thank the Minister for his Answer, which was not unexpected. Do the Government appreciate that the possibility of a scrappage scheme was first discussed in autumn 2008? If further delay takes place, and the Governments plans are to make a decision when the Budget comes at the end of April, does the Minister accept that there will a lengthy time before any such scheme could be introduced? It could be the autumn before there is any impact on the second-hand car industry, which will have been nearly a year since the proposal was first mooted.
Lord Davies of Abersoch: My Lords, the interesting thing about this scheme is that it needs to be carefully evaluated. It is clear that the German scheme has cost the taxpayer €1.5 billion. If we are to introduce a schemewe have not decided whether this is appropriatewe must ensure that we evaluate the impact on the second-hand car market and on discounts. There are many complex aspects to introducing a scheme. That is why we are taking our time: we need to get it right. We have introduced many schemes over the past few months to stimulate the economy. We have got them right because we have taken time to consider them.
Lord Berkeley: My Lords, does my noble friend agree that, if he is going to pay me £2,000 or so to sell my old car and buy a new one and if I was the owner of a railway train, passenger or freightI declare an interest as chairman of Rail Freight Groupcould I hand in my old trains, of which there are many, and be given a subsidy to buy new ones in the same context?
Lord Davies of Abersoch: My Lords, I was going to refer to an economists view but, given that the economists have come in for such a battering, I will not. However, any scheme that we introduce needs to ensure that while we are rewarding the individuals bringing their car back and giving them cash, the impact on the industry is not just that of bringing forward sales and causing a crisis in the second-hand car market. On trains, I am afraid that I have to pass.
Baroness Gardner of Parkes: My Lords, has the Minister seen the figures saying that nearly allover 80 per centof new cars are imports to this country? Our car manufacturing industry is mainly exporting cars. Although I am very much in favour of updating cars, is there not a risk that the scheme will not have the benefits to the economy that we hope?
Lord Davies of Abersoch: My Lords, I have been in my role as Minister of Trade for about two months. One thing that I have realised about British industry is that we are expert in advanced engineering, but also hugely competent in the automotive industry. We in the UK produce 3 million engines annually that are exported. An issue is that the scheme would benefit overseas as well as UK manufacturers; we need to consider that carefully.
Lord Trefgarne: My Lords, like the noble Lord, Lord Berkeley, I declare an interest. I am chairman of a museum that owns a large number of veteran and vintage vehicles. Can the Minister assure me that his scheme will not adversely affect such people?
Lord Davies of Abersoch: My Lords, as this is my first Oral Question, I have been given significant briefing. There was no mention in the briefing of vintage cars. The experience of other countries shows that such schemes have been for cars over a certain age. I would therefore assume, given the value of vintage cars, that they would not be submitted for scrapping.
The Minister mentioned old vehicles. The intention would be to recycle them as part of the scheme. There would be environmental benefits to be looked at, in that vehicles replacing the old ones would be environmentally better for the roads. All these issues are to be considered. The cost issue must also be considered, but there are also benefits in terms of fresh sales for the Government as well as the hidden benefits of fewer accidents and a lower impact on the environment. Can we have a quick decision?
Lord Davies of Abersoch: My Lords, the noble Lord will have a quick answer. We will evaluate carefully who runs the scheme, who pays for it, how long it might run, the amount of any scrappage payment and the age of eligible vehicles. There are many complex issues here. When we have evaluated the scheme properly and decided yes or no, the noble Lord will be the first to know.
Lord Davies of Abersoch: That is a very good question, my Lords. One of the challenges with such a scheme is to make sure that the second-hand car market does not collapse. You also have to make sure that you are not just creating a sudden demand for new cars, and a year or 18 months later the whole industry collapses. We need to make sure, in evaluating this, that the discount market for new cars does not suddenly disappear.
With permission, Mr Speaker, I wish to make a Statement about Stafford Hospital, following the Healthcare Commissions investigation published yesterday. The report details astonishing failures at every level and shows that for patients admitted for emergency care at Stafford there were deficiencies at every stage.
The Healthcare Commission found disorganisation, delays in assessment and pain relief, poor recording of important information, symptoms and requests for help ignored, poor communication with families and patients and severe failings in the way the trust board conducted its business. While the management was obsessed with achieving foundation trust status, the wards were understaffed and patient care seriously compromised.
The report cites incidents where patients were left without food or drink for days because operations were delayed, of nurses who had not been properly trained to use basic, lifesaving equipment and of patients admitted to A&E being triaged by receptionists. It notes that there was a dangerous lack of experienced staff, that observation and monitoring of patients was poor, that essential equipment often was not working and that there were no systems in place to spot where things were going wrong in order to make improvements.
In short, it is a catalogue of individual and systemic failings that have no place in any NHS hospital but which were allowed to happen by a board that steadfastly refused to acknowledge the serious concerns about the poor standard of care raised by patients and staff. I apologise on behalf of the Government and the NHS for the pain and anguish caused to so many patients and their families by the appalling standards of care at Stafford Hospital and for the failures highlighted in this report.
I will set out the actions that we will take in response to this report during my Statement, but I want to begin by summarising the events that lead to the Healthcare Commissions investigation. The commission became aware of high mortality rates for specific conditions or operations at this trust during the summer of 2007, through its routine analysis and statistics known as hospital standardised mortality ratios, or SMRs, produced by the Dr Foster research unit, based at Imperial College.
Whenever the Healthcare Commission is alerted to unusually high mortality rates, it initially asks the trust to provide further information to explain such anomalies. High standardised mortality ratios are not necessarily an indicator of poor clinical performance, nor do they signify that there have been avoidable deaths, but they do act as a screening tool to identify the need for investigation.
Further analysis showed that there were consistently high mortality rates for patients admitted as emergencies going back several years. The trust repeatedly dismissed
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In May of that year, following its first visit, the commission asked to see the chief executive and set out its immediate concerns about poor patient care and inadequate staffing levels. Since then there has been gradual improvement. The Healthcare Commission states that,
On an unannounced visit in February to the accident and emergency department the Healthcare Commission noted significant improvements. Its visit raised no immediate concerns about the safety of patients admitted to the accident and emergency department. However, the failures are stark and they occurred over a substantial period of time.
Patients will want to be absolutely certain that the quality of care at Stafford Hospital has been radically transformed and in particular that urgent and emergency care is administered safely. I have today, jointly with Monitor, asked Professor Sir George Alberti, the eminent physician and national clinical director for urgent and emergency care, to lead an independent review of the trusts procedures for emergency admissions and treatment and its progress against the recommendations in the report. He will report in five weeks time and his findings will be published to the House.
The Healthcare Commission has told me that it is confident that Stafford Hospital is an isolated case and that, having looked at other trusts with similarly high standardised mortality ratios, it is reassured that a similar succession of serious lapses in care has not occurred elsewhere.
The National Quality Board has been set up to look at how organisations work effectively together in patients best interests. It is composed of representatives of the royal colleges, patient groups, regulatory bodies and clinical experts. I have asked the board to look at how we can ensure that any early signs that something is going wrong are picked up immediately, that the right organisations are alerted and that action is taken quickly.
The public and the House will want to know how the problems at Mid Staffordshire could have remained undetected for so long. One of the reasons why the Healthcare Commission began its investigation was that, after having initially been alerted to problems in the trust, it became clear that there had been serious failings for some time. The Healthcare Commissions report raises serious concerns about why the primary care trusts and the strategic health authority either failed to spot the problems at the trust or, having spotted them, failed to act.
I have asked Dr David Colin-Thomé, the national clinical director for primary care, to review the circumstances surrounding Mid Staffordshire trust prior to the Healthcare Commissions investigation to learn lessons about how the primary care trusts and the strategic health authoritywithin the commissioning and performance management system that they operatefailed to expose what was happening in this hospital. His recommendations will focus on what commissioners across EnglandGPs and PCTscan learn from this case to be sure that they are advocating effectively on patients behalf.
Our principal concern today must be to reassure the families and friends of patients who have died at Stafford Hospital that they will be able to ascertain whether any of the failings detailed in the Healthcare Commissions report contributed in any way to the death of their loved ones. As the Healthcare Commission has said, it is not possible to determine conclusively from any set of statistics whether there were any avoidable deaths due to poor standards of care. That can be done only through a case notes review. I can confirm that the new leadership of the trust will respond to every request from those relatives and carry out an independent review of their case notes to determine whether or not the care that they or their loved ones received was appropriate.
The failings at Stafford hospital are inexcusable. I hope that we can close this chapter in the hospitals history by acknowledging and addressing past failings and by ensuring that lessons are learnt by government and the NHS at all levels to make sure that these terrible failures are never allowed to happen again.
Earl Howe: My Lords, the House will be grateful to the Minister for repeating the Statement. The report published by the Healthcare Commission makes truly appalling reading. This is a trust where failure was not sporadic or of short duration, but systemic and long term. The list of failings could not be more damning: chronic understaffing, patients starved and neglected on the wards, a lack of basic staff training, poor record keeping, equipment that did not work, an inexcusable lack of professionalism in A&E and, perhaps most concerning of all, a steadfast refusal to take seriously the complaints and worries of patients and their families. Quality of care in these hospitals was a phrase with little substantive meaning.
None of us can feel anything but shame that such a hospital could operate like this in the NHS for so long and, furthermore, that it should be a foundation trust. We need to have confidence now that the right questions will be asked of the right people and that the right lessons will be learnt. The Statement pertinently asks what on earth the strategic health authority and the local PCT think that they have been doing all this time. What kind of performance management has the strategic health authority been engaged in and why does a PCT, if it pretends to be on the ball, continue to commission emergency care services from a trust whose standards of performance, even at an anecdotal level, should have raised serious question marks?
I do not want to personalise this debate, but the chief executive of the strategic health authority, Cynthia Bower, has been appointed as chief executive of the Care Quality Commission, the new health and social care watchdog. Ms Bower allowed herself to be deceived into thinking that the anomalies emerging from the mortality statistics were the results of coding errors, not anything more sinister. How and why did that happen?
Looking forward, is the Minister confident that the process of registering NHS providers by the Care Quality Commission will be sufficiently rigorous, bearing in mind that registration will depend on the quality of care being delivered in a given organisation? Will the new system of quality accounts ensure that failings in basic care, such as those at Stafford, are recognised and dealt with in a timely way?
Those questions remind us that the point of debating a Statement of this kind is not only to talk about a particular NHS trust, but also to look at its implications for public policy more widely. Mid Staffordshire NHS Trust became a foundation trust only last year, yet well before that, in 2007, serious concerns were voiced about mortality rates in the trust. At what point did the Secretary of State become aware of these concerns? Why was the trust allowed to acquire foundation status in the face of an impending investigation by the Healthcare Commission? What questions were asked at that time about the quality of the senior management in the trust? Did Monitor ask those questions before ratifying the trusts new status?
When the Healthcare Commission wrote to the chief executive at Stafford on 23 May last year requiring urgent action, what did Monitor do about it? The report shows that this was not a case of a corner being turned as soon as the commission flagged up the trusts shortcomings; as late as September of last year, the commission says that it found,
The individuals leading the trust may well have taken some action, but essentially they were in denial. Even when the chief executive resigned a fortnight ago, he said that he was proud of what had been achieved and that it was his decision to leave. Why was it his decision? Did no one ever consider removing and replacing the senior management at an earlier stage? There was no intervention of this kind by anyone. Why not?
Is the Minister prepared to acknowledge that the Government bear some responsibility for this chapter of failures? We have seen in the NHS in the past few years a constant round of organisational change and a dogged obsession with narrow process-related targets. Stoke Mandeville, Maidstone and Tunbridge Wells and now Stafford were all hospitals that were directed towards goals other than good patient care: meeting waiting-time targets, managing organisational change and avoiding overspending their budgets. The Healthcare Commission said, about a year ago:
We have found that the boards of NHS trusts we have investigated are particularly vulnerable to being consumed by the business of healthcare, in the form of mergers, reconfiguration of services, financial deficits, and targets.
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