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6 May 2009 : Column 121WH—continued

My first suggestion is that that paragraph be widely publicised.

The hon. Member for Stafford had two—he had more, actually, but I refer just to the first two—board meetings in public. Of course such meetings have to be in public. People must be given a chance to report what is going on and their suspicions. Again, in Prime Minister’s questions today, I think the right hon. Gentleman mentioned that there should be stronger patient and public involvement. We have these funny things called LINks—local involvement networks—which are very variable across the country. Where were they in Stafford? Presumably, they had not really got off the ground—in fact, all over the country LINks have been slow to set up.

I shall mention another point from New Zealand. In one hospital that we visited, it was a strategy for all the staff to ask whether the patient would pass the granny test— “Would you mind your grandma being in that hospital?” I do not think that I have quoted Private Eye before, but I have a regard for that publication and what it sometimes publishes. In the 17 to 30 April issue, we were reminded:

What a condemnation!

Since this debate was announced, I have had a number of communications. A helpful communication was sent by Dr. Rod Storring, who asked why the question to which I have referred is not still asked. He points out that a number of related questions can be answered by staff anonymously and he suggests that those could be used

These statements are, I think, still in the staff survey:

I agree with Dr. Storring. Those statements should be put to staff anonymously as a litmus paper test of how the trust is doing.

Finally, I do not know whether this is possible in the UK, but I shall mention a radical change. In New Zealand, they have a health and disability commissioner who is accessible to patients and staff through outreach work. He believes—these are not quotes; they are his thoughts on the matter—that patients must have an independent medical opinion available to them and an easily available advocate, which he regards as his job. He would welcome whistleblowers, provided they have a real case about which to blow the whistle and they are absolutely honest. If the mid-Staffordshire and Brighton cases achieve anything to improve the future quality of care, it will be to blow wide open the fact that there is protection for whistleblowers and that they can speak out without fear of victimisation.

4.16 pm

The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate the hon. Member for Wyre Forest (Dr. Taylor) on securing this debate on such an important and topical issue. Let me at the outset state unequivocally that the Government support whistleblowing and the NHS is expected to support it too.

The NHS exists to serve the needs of patients and the public, not for the convenience of managers or staff. Staff have the right under the law and a professional duty to raise any concerns that they may have about the quality of patient care with their employer. They must feel free to raise legitimate concerns with their line managers, more senior managers or, on occasion, publicly. NHS organisations are required to have policies and procedures in place that support, encourage and celebrate whistleblowing. In well run organisations, it should not get to the stage where staff feel they have to approach their MP or go to the media. Legitimate concerns will be listened to and acted on.

Of course, it may not always be easy to distinguish between someone who has a genuine, legitimate concern, and someone with a personal grievance or axe to grind. Good management is about being able to make the distinction in an atmosphere where people feel able and encouraged to come forward. Of course, there is also an onus on the concerned member of staff to act responsibly and professionally. They should go through the correct procedures first and only go public if they feel their concerns are not being listened to or acted upon.

Back in 1998, one of the first pieces of legislation passed by the new Labour Government was, as the hon. Gentleman has mentioned, the Public Interest Disclosure Act 1998, which provided statutory protection for whistleblowers for the first time. He described it as a vital piece of legislation—and, indeed, it is. It came partly in response to a report by the Nolan Committee on Standards in Public Life, which had criticised the fact that people often felt compelled to go public with concerns because of the lack of protection for whistleblowers and the lack of robust procedures in place for organisations to deal effectively with employee
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concerns. The Government require every NHS organisation to have policies and procedures in place to comply with that Act.

Indeed, we have seen a significant increase in the number of successful whistleblowing exercises thanks to the Act, and there have been hundreds of successful uses of the Act—for example, the case of a cleaner at Charing Cross hospital, who raised concerns about cross-contamination due to unsafe hygiene practices in 2005. She was initially dismissed, but an employment tribunal found that her concerns were well founded and that the 1998 Act applied. She was reinstated and awarded £7,000 compensation.

We have also commissioned a charity that specialises in the issue called Public Concern at Work. It provides an independent helpline that is staffed by lawyers with expertise in whistleblowing. That is available to all NHS staff and calls are treated in the utmost confidence. Last year, Nursing Standard magazine, along with Public Concern at Work, asked nurses about whistleblowing. Of those who had been concerned about a serious risk to patient safety in the last three years, 87 per cent. had raised that concern—43 per cent. did so with their line manager, 18 per cent. with their team leader and 20 per cent. with senior management. Some 232 nurses said that they had successfully blown the whistle and protected patients from harm by doing so. When asked if they would raise such an issue again, 85 per cent. said that they would.

Public Concern At Work said:

We also know from our staff surveys that more and more NHS staff know about their right to whistleblow and how to go about doing it.

The hon. Gentleman raised two recent high-profile cases that have brought whistleblowing to people’s attention. Let me deal first with the case of Margaret Haywood. She was the nurse who, in 2005, helped the BBC’s “Panorama” programme make a film highlighting poor quality care at the Royal Sussex hospital in Brighton. She was recently struck off by the Nursing and Midwifery Council. I do not intend to go into the ins and outs of the case. The NMC is an entirely independent professional regulatory body and its fitness-to-practise panels operate independently within it. That independence is a vital component in securing public confidence in the system. Hon. Members can read the NMC panel’s report at their leisure.

It is still open to Mrs. Haywood to appeal to the High Court against the decision. Her union, the Royal College of Nursing, has said that it will support her in any appeal and has made it clear that it thinks that, given the range of sanctions available, the decision to strike Mrs. Haywood off was unduly harsh. Having studied the report myself, and having considered the wider implications of the ruling on our whistleblowing policy, I have to say that I agree with the RCN’s position.

I can confirm, as the hon. Gentleman asked, that the NMC does not have the power to overturn the decisions of its panels itself. The appeal must be made to the High Court.

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The second recent high-profile case that the hon. Gentleman raised in connection with whistleblowing was the devastating report by the Healthcare Commission into the standards of care at Stafford hospital. He raised one of the great questions in this case, which was highlighted in the Healthcare Commission report and by others who have looked into events at the hospital in more detail: where were the whistleblowers? Where were the professionals, the royal colleges and the unions?

Since the report was published, there have been suggestions that some staff did raise concerns but were not listened to. I urge anyone who has had experience of that or has had it reported to them to bring evidence of such examples forward. But, to be frank, given what we know was going on at the hospital, one would have expected not one or two whistleblows but a cacophony of whistleblowing. One of the things that is clear about how the hospital was run is that there was a closed culture in which the management failed to take public and staff concerns seriously.

In response to the two follow-up reports on Stafford hospital that were published last week, the Government announced a range of measures to ensure that NHS organisations fulfil their existing obligations to include the public and staff in decision making, including taking their concerns seriously. We also announced that we will reinstate a question in the annual staff survey asking people what they think of the quality of care where they work. As the hon. Gentleman rightly said, it was one of the measurements that helped alert the Healthcare Commission to the problems at Stafford. I understand that the commission—it is its survey, not ours—dropped the question in 2007 because of concern that it might skew results against certain types of provider; for example, a psychiatric hospital where staff may answer when asked whether they would be happy to be treated in their hospital with, “No, because it would mean that I have a mental health problem.” A problem with the wording led the commission to drop the question from its survey, but we strongly believe that asking staff what they think of the quality of care in their hospital is important, and that, done anonymously, it can tell a great deal about the quality of care at a hospital.

I hope that I have made it absolutely clear to the hon. Gentleman, both in my general remarks and in what I had to say about the Margaret Haywood and Stafford hospital cases, that the Government fully support whistleblowing. We have provided unprecedented legal protection for those who whistleblow and have emphasised those rights in the new NHS constitution. We will not tolerate management that bullies or discourages whistleblowers. Listening to and acting on the concerns of staff are vital ways to drive up standards and help ensure against poor or unacceptable quality care.

4.25 pm

Mr. David Kidney (Stafford) (Lab): I congratulate the hon. Member for Wyre Forest (Dr. Taylor) on securing such an important debate.

Recently I was watching the regional television news—I believe that it was for Warwickshire, not Staffordshire—and there was a story of a doctor who was celebrating getting his job back seven years after he had been wrongly suspended from work for whistleblowing. It is one thing to say that there is already a law that protects
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people, but when clinicians read or see that they could have seven years of hell for whistleblowing, it is not that much consolation that the law is as it is.

I was at a public meeting in Stafford last night, which I mentioned at Prime Minister’s questions today. The room was packed with angry people who had suffered terribly either because of the loss of a relative or because of how they had been treated by the hospital. They told some frightening stories about hospital staff being bullied to make them toe management’s line. We need to say that that is totally unacceptable throughout the national health service, and I was pleased that the Minister firmly stated that to be the case.

I was interested by the hon. Member for Wyre Forest saying that in his day the hospital was run by the doctor, the nurse and the administrator. I have had a couple of letters since all this blew up in my local media, one from a retired consultant and one from a retired doctor. They both make the same point about the rise and rise of the manager. It is no longer the administrator but the manager who controls the hospital—the consultant has been pushed aside. One thing that we could say, independently of Stafford, is that Lord Darzi’s report last year on quality care and restoring the centrality of the clinician’s role in our health service is an important development that we must support and sustain.

I am sorry to bring Stafford into the hon. Gentleman’s debate, but he was right to say that, in the end, it is the public, the patients and the patients’ relatives supporting a caring staff in the hospital, and the dialogue between the two groups, that will eradicate the kind of problems that he described and that I have just described in my brief contribution.

4.27 pm

Dr. Tony Wright (Cannock Chase) (Lab): I declare an interest, in that I initiated the thought that we might have a whistleblower protection Act more than 10 years ago. It finally became the Public Interest Disclosure Act 1998. I knew that whistleblowing mattered, but I did not realise that we would have a situation such as Stafford, where the absence of whistleblowing was so
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serious. It is perplexing why that was the case, and we need to do more investigation into it.

The Minister referred to a closed culture, and that is what the report clearly said was the fundamental problem. It is all right having general whistleblowing procedures, and what the Government have produced in the years following the 1998 Act is very good. The stuff that the Department has put out is excellent—it says all the right things—but the test for guidance is what happens to it on the ground. What happens to it when it confronts, as the Minister said, a closed culture such as the one in Stafford? Is the guidance good enough to convert it into a different culture? Can it break open the kind of closed culture that we saw in Stafford? Clearly not.

I urge the Minister to reinforce the guidance, to do all the things that he is doing, to have the helpline and so on, but also to accept responsibility for ensuring that every health organisation in this country not only has words on a piece of paper but puts into practice a robust whistleblowing policy that staff have the confidence to use. If they do not do that, we shall again ask after another incident involving horrors like those at Stafford: why were people not able to speak out in the way that they clearly ought to have done?

Mr. Mike Hancock (in the Chair): The Minister has 30 seconds.

Mr. Bradshaw: I entirely accept what my hon. Friends the Members for Stafford (Mr. Kidney) and for Cannock Chase (Dr. Wright) have just said. Briefly, in response to my hon. Friend the Member for Cannock Chase, I invite him, if he has not already done so—I am sure that he has—to study the details of what was announced last week in response to the David Colin-Thomé and George Alberti reports. Without going through the details, many important new measures and expectations were announced for providers and primary care trusts to ensure that exactly what he is advocating is delivered on the ground.

Mr. Mike Hancock (in the Chair): Thank you. That was good timing. Could those Members who have taken part depart quietly? We now move on to the next debate. The hon. Member for West Lancashire (Rosie Cooper) is about to take her place, and the Minister is eagerly anticipating her words.

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Concessionary Bus Travel

4.30 pm

Rosie Cooper (West Lancashire) (Lab): I welcome the opportunity to bring this debate before you, Mr. Hancock. During my time as a Member of Parliament, transport, including the whole gamut of bus and rail services and roads, has been one of my main priorities. Transport is at the heart of many issues affecting the residents of West Lancashire, given the size of its geographical area.

I wish to cover two specific issues during this debate. First, some local authorities that are net gainers through the local funding regime are not maximising potential concessionary travel benefits for their local residents. Secondly, some local bus companies are fraudulently issuing tickets, meaning that they are, in essence, overpaid for the journeys taken. Local authorities are thus being overcharged, and pensioners are left worried that the scheme is devalued, that it might not last, and that they might have been involved in fraud.

I put on record my support for the Government’s national concessionary travel scheme, which has opened up a wealth of opportunities for older and disabled people across the country by removing the cost barrier to public transport. West Lancashire residents rely on public transport to enable them to get access to vital public services, such as their general practitioner or a hospital, to take up employment opportunities, and to take an active part in social and leisure activities.

My aim is for pensioners to get a fair deal on concessionary transport. Older people in West Lancashire look on with envy as their neighbours in Wigan and Southport travel for free on buses and trains, often into West Lancashire. They, too, would like the chance—and the choice—to hop on a train and visit their friends and relatives and to take full advantage of the social and leisure opportunities in Liverpool, Southport and Wigan. I have taken to the streets alongside local pensioners, and our petition has collected more than 2,500 names, which shows clearly the strength of local feeling. We have met council officials to discuss the issue, and pensioners have protested at the district council’s budget meeting, holding posters saying, “We don’t want to be Merseyside’s poor relations”, but all to no avail.

I understand budgetary constraints. However, it is interesting to look at the funding received by West Lancashire district council. In 2006-07, it was estimated to have received an outturn of £295,754. Under the national funding formula, it received an additional £910,000, giving it a total allocation for 2006-07 of £1.2 million. That represented a funding increase of 6.2 per cent., which was the fourth largest in Lancashire, although you would not have noticed it, Mr. Hancock.

According to the figures for the concessionary fares special grant distribution in West Lancashire, the district council has been allocated £760,000 for 2008 to 2011. In May 2006, the council agreed to—as it would say—prudently set aside a contingency of £210,000. However, I would say that the money was taken away from pensioners and not used, as the Government intended, to help them get out and about on public transport.

According to budget figures for this year, the council has a projected surplus of £133,000 before its pooling arrangement with other Lancashire authorities and a post-pooling projected sum of £50,000. It is unfairly using the surplus to offset other council services.

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