My first proposition is that accountability without transparency is entirely meaningless. The ability to see what is going on and how decisions are being made in the health service, and to see the effects of those decisions, is fundamental to the delivery of the objective of culture change. With respect to the right hon. Member for Leigh—and, indeed, to some of the points that my right hon. Friend the Secretary of State made—we have to acknowledge that a lack of transparency lies deep in the culture of the health service, and that it goes back to way before the previous Government were in office. It was present in my time as Secretary of State and well before that, too. I was regularly accused of supporting a

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gagging culture in the health service, although nothing could have been further from my intention. However, that charge was made against me, against the right hon. Members for Leigh and for Kingston upon Hull West and Hessle (Alan Johnson) and, in truth, against all our predecessors right back to 1948.

The instinct to protect, rather than the instinct to reveal, is deeply embedded in the health service. When something is said to be going wrong, there is an instinct for the wagons to gather round. That is why Francis’s recommendation for a duty of candour is key to the delivery of the objective of greater accountability and transparency.

Barbara Keeley: Was the right hon. Gentleman as disturbed as I was to hear that the £500,000 gag at the United Lincolnshire Hospitals NHS Trust was put in place without any sign-off whatever, on the basis that it had involved judicial mediation? The Secretary of State refused to answer my question about this. Does the right hon. Gentleman agree that the Secretary of State really has to stop that, because it involved a very large amount of money, which was used very ill-advisedly?

Mr Dorrell: The position I take is the one set out in the Francis report, which was explicitly endorsed by Sir David Nicholson in the Select Committee inquiry to which the hon. Lady has referred. I believe that it would also be endorsed by my right hon. Friend the Secretary of State, but he must speak for himself. That position is that it is hard to imagine circumstances in which the use of public money in the context of a compromise agreement should be governed by a confidentiality clause. In an age when a bill from Pizza Express has to be published on the internet, decision makers should be held publicly accountable for the use of large sums of money in the context of a compromise agreement.

Mr Jenkin: I accept my right hon. Friend’s challenge about openness and transparency in the way the health service reacts outwardly, but that is a means to an end. There is also a lack of honesty and openness between people working in the health service, and the mistrust between levels of management and institutions inhibits the proper flow of information and the ability of people to trust each other in the context of saying what is wrong and putting it right. People in the health service dare not tell their senior management what is wrong.

Mr Dorrell: I have a lot of sympathy with what my hon. Friend says. The successful delivery of a culture change that supports real transparency would build on the fact that it is not only a right but an obligation for a registered doctor or nurse who sees care being provided that falls below proper standards to raise their concerns and, if no action is taken, for those concerns to be raised with the regulator. Change will be required right through the health service if that professional obligation is to be made real.

John Pugh (Southport) (LD): My right hon. Friend has mentioned the instinct to protect and to circle the wagons. Would he accept, however, that that is not exclusive to the NHS, and that it also exists in the police service, for example? It also existed in Parliament during the expenses scandal. It is an institutional feature of many kinds of organisation.

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Mr Dorrell: I agree with my hon. Friend, but I hope he will forgive me if I do not follow him down the road to the police service in the three and a half minutes I have left.

My key objective is to enable Members to recognise that this is a deep-seated cultural issue, that we need to create a more open culture, and that a duty of candour is fundamental to that. I say to the right hon. Member for Leigh that we need to ask ourselves occasionally: accountable to whom? Surely in the first instance, the health service must be accountable to the patient. How can it ever be right for a failing in care provision that has been acknowledged and discussed not to be described to the patient? That duty of candour to the patient is fundamental to the culture change that I am describing. However, we have to remember that, within the tax-funded health care system, there is a duty not only to the patient but to the taxpayer. Although I do not want to go too far down this road, the challenge for the right hon. Member for Leigh when he speaks about competition and decisions about the use of public money is that commissioners and providers must be accountable for value as well as clinicians being accountable for quality.

In my remaining time, I want to pose this challenge for those elected to this House. The challenge of culture change has to apply right through the health service, but people looking into this debate from outside will, I suspect, conclude that thus far that challenge has not been fully responded to. There is a deep-seated culture here that pretends that the problems all started under this or that lot, or that every success is the result of achievements made by one particular side, but the truth is that this deep-seated requirement for culture change has been addressed by successive Governments over a protracted period.

We should not forget that waiting time targets were invented before I was Secretary of State for Health. Quality of care requires access to care as well as to high-quality clinical outcomes. We should not forget that deep in the pathology of what happened in Staffordshire, the health economy there was out of control. It was running sustained deficits and management was required to bring that health economy under control. There is no choice between quality on the one hand and management on the other. We need to develop a culture within the health service that allows managers to address questions of both quality and value, because unless we address both, we will deliver neither. That is the core challenge facing the health service over the period ahead.

1.51 pm

Kate Hoey (Vauxhall) (Lab): It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell), who speaks with a breadth of experience and history in the national health service, and I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on securing this long debate, providing an opportunity to all of us to say a few words.

I agree wholeheartedly with everything my hon. Friend the Member for West Lancashire (Rosie Cooper) said, particularly about what seems to me, too, to be a growing public body desire for secrecy. This is happening not in the national health service alone, but in many other bodies. Indeed, as my hon. Friend well knows, it is happening in this House. I am concerned about a number of issues—how staff are treated, getting rid of the

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telephone exchange and a whole number of other decisions taken up there somewhere. We, as Members who work here, have very little say.

It is important for us to remember the Nolan principles of public life to which every public body is meant to sign up—accountability, openness, honesty and leadership. I do not want to say much specifically about what happened in Mid Staffordshire, but it was appalling. As someone who has had a good and well-led hospital in my constituency for many years, I find it almost unbelievable that all that could have happened in the Mid Staffordshire hospital with so few people seeming to know what happened or to speak out about it. Then, when it was pointed out, no one listened. That provides a terrible warning about what can happen. We all think that we know what is happening in our constituencies, but we do not always, as this episode has shown.

Let me talk about my local hospital Guy’s and St Thomas’, King’s College hospital and SLAM—the South London and Maudsley hospital. What has been called the “King’s Health Partners” has sought to bring together the research work at King’s College medical school with others, and the body is now growing to be almost an entity in itself, making decisions, sending out publicity and getting further and further away from the foundation trust.

Looking back to when my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was Secretary of State for Health, some of the decisions he made in the Health Act 1999 were more about accountability than anything that has been done since by any Government. For example, he instructed NHS chairmen to hold their board meetings in public, while non-executive directors were required to live in the area served by the trust—a crucial step that fundamentally changed St Thomas’ hospital when we had a local chairman who knew the area, was involved in the hospital and cared about it. She spent all her time as chairman wandering around the hospital trying to find out about everything that was going on: she was accountable to everyone. That was crucial to the public, too, as they knew that they had people on the board who knew what was happening in the locality.

I believe that one of the first responsibilities of non-executive directors—they are not part of the management —is to visit the wards, to talk to patients, to collate local concerns and to talk to MPs, local councillors and the local authority. That was always happening. We had a very good system. There were concerns about the treatment of the elderly at one stage in one of the wards for elderly people at St Thomas’, but they got dealt with very quickly because we had a responsive chairman and a responsive board. A lot of that happened when my right hon. Friend the Member for Holborn and St Pancras was the Secretary of State. The Health Act 1999 also gave the chief executive officer absolute personal responsibility for clinical governance standards—another important reform—in addition to the responsibility to be the accountable officer.

Later we had foundation trusts, although I have to say that I did not vote for them. I have had a well-led foundation trust up to now, but I did not feel that this was the right way ahead for the national health service at the time. We have got them, however, and some foundation trusts saw fit to erode the principles as financial considerations took precedence over clinical standards on many board agendas. The foundation trusts still remain the chief executive officer’s responsibility.

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One thing the King’s Health Partners are doing in the name of foundation trusts is steamrolling ahead to bring about a merger of Guy’s and St Thomas’ hospital, which is a huge trust, King’s College hospital, which is another huge trust, and the South London and Maudsley trust. It is believed that the merger will somehow lead to a “world-class”—I do not know how many times Members have heard the term—hospital.

I am furious and angry—as are, I think, all five of the MPs representing the area at how this merger has been handled. The lack of openness has been appalling and there has been no public board meetings or disclosure of information about the proposed changes. The proposals have been either badly put forward or not put forward at all. The board at St Guy’s and St Thomas’ has an occasional surreal meeting as a showcase for public involvement, but it never discusses the real issues. It opens meetings for the public only when it suits the board.

Lyn Brown: Does my hon. Friend agree that the plans for reorganisation of the trusts south of the river need to be put on hold?

Kate Hoey: That is precisely what the five Members of Parliament have asked for. Recently, on 28 February, we heard from the chairman of Guy’s and St Thomas’, who was previously a permanent secretary at the Department of Health. That takes me back to one of my earlier points about people moving around within the health service. It is always somebody who has been someone else in somebody else’s patch that gets a job with another NHS trust. This chairman wrote to say that the project is forging ahead with a full business case. William McKee, who brought together trusts in Northern Ireland, has been appointed and we are told that he is going to spend at least £5 million to bring about the business case to show why this will be such a wonderful idea. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and I have written back asking who is actively responsible, how the money from the different bodies is being allocated, what the precise budget will be and how it will be spent by whom. The whole accountability thing is there in a nutshell. Who is actually accountable? Does the Secretary of State have any say whatsoever? No. Apparently he is only interested if the move will clearly not be good for patients in clinical terms.

I know that the establishment of such a large trust will be totally against the interests of people. Trusts cannot operate on such a large scale. One chief nurse cannot be responsible for all those hospitals.

1.59 pm

Dr Phillip Lee (Bracknell) (Con): As ever, it is an honour to follow the hon. Member for Vauxhall (Kate Hoey).

Let me begin by congratulating my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing a debate about this important subject. It is a subject that I think should be debated more often in the Chamber, and I find it surprising that fewer Members wish to speak about it than have wished to speak about some of the other issues that we have considered since Christmas. I think all Members should reflect on that.

I believe that the core of this problem is responsibility: responsibility in public life. The general public are fed up—not increasingly fed up, but completely fed up—with

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hearing about scandal after scandal involving the national health service, the BBC, the newspapers and so on, for which no one takes any responsibility. No one walks. No one looks at themselves in the mirror in the morning and says “I did not do as well as I should have; I am paid a decent wage; the honourable thing to do is resign”—not “be sacked”, but resign.

I do not want to make a speech about Sir David Nicholson. Sir David Nicholson should know that he ought to resign. I cannot comprehend how he can think that his position is sustainable from a moral standpoint, but if no morality is involved, what about competence? He may have been head of the strategic health authority for only a relatively short time, but he was aware of the mortality rates when he was in that job. What did he do about it? If he did nothing about it, why is he still in post? However, I do not want to make this a personal issue.

Having worked in the national health service for 13 or 14 years, I do not need to be told about the problems caused by the culture in that institution. I learnt how it was as a medical student, and I saw it at first hand as a junior doctor. I want to say something about that, and also about competence in general. We need competent individuals in charge of our hospitals and on hospital wards, but I am not sure that we have had them in recent years. I also want to say something about responsibility in the light of that.

The national health service is a huge institution—some might say too huge—and because of its size, the fact that it has grown over the past 60 or 70 years, and the fact that the people who work in it rarely leave, institutionalised behaviour is rife. It is rife in medicine and in management. In my view, former Secretaries of State on both sides of the House display such institutionalised behaviour themselves. They may wish to reflect on that at the end of the debate.

The first debate in the House in which I spoke, apart from the debate during which I made my maiden speech, was a Backbench Business Committee debate about compensation for haemophiliacs. I was struck then by the institutionalised response from the Department of Health. It seemed plain that the Department did not want to set a precedent by doing what was obviously the right thing, namely compensating about 4,000 people and their families for what the system had done to them.

I am therefore not surprised by the Francis report, which those who read it will discover to be a not particularly impressive document. Parts of it have the ring of a Nuremberg defence. It is remarkable that individuals cannot be held responsible for their actions within a system. That system is apparently so perfect that no one within it needs to be good. I think that we need a health service in which individuals, including Secretaries of State, take responsibility for their decisions at every stage.

Mr Cash: Was my hon. Friend surprised, as I was, that neither of the Secretaries of State who were in charge at the time were called to give evidence to the inquiry? Did he find that very strange?

Dr Lee: I did find it very strange. In fact, I find the behaviour of both former Secretaries of State strange all round. There is a constant blaming of—

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Mr Cash: May I just correct one thing? The shadow Secretary of State was called to give evidence, but not the previous two Secretaries of State.

Dr Lee: I am talking about those who were Secretaries of State in the last Administration. In response to an intervention during his speech, the right hon. Member for Leigh (Andy Burnham) said, “I passed it on to Monitor.” The attitude that leads people to push away the process of decision making and take no responsibility for the outcomes needs to end.

Andy Burnham: Surely, as a clinician, the hon. Gentleman would resent the idea of politicians’ interfering in the independent clinical regulation of hospitals. I did not do nothing. Within days I had asked the Care Quality Commission to investigate the outliers that Brian Jarman had given me. I will not sit here and accept the hon. Gentleman’s suggestion that I complacently did nothing. That is not true, and he should not repeat it in the House.

Dr Lee: Despite that, nothing changed, did it? The CQC has a terrible reputation in my profession, and to have handed the matter over to it—when it was run by someone who was implicated at Mid Staffordshire—is not a defence.

Let me broaden the discussion to something that I may know something about: practising medicine in organisations run by the Department of Health. I can tell the House that the prevailing atmosphere is one in which attention is not drawn to problems. There is a fear for jobs down the line. Let me give an example. When I was a junior doctor, I misused a photocopying machine in a hospital. Within hours, I received a phone call from a middle-grade doctor telling me that if I did that again, it would affect my reference. The phone call, I was told, had been authorised by the then consultant general surgeon at St Mary’s, Ara Darzi. I reflected on that at the time. It made me feel rather intimidated. [Interruption.] The prevailing mood in hospitals was that seeing or doing something wrong could adversely affect a person’s future career.

Charlotte Leslie: Does my hon. Friend share my regret that Opposition Members are groaning in that way? What he is describing has been very evident for very many years. One need only speak to a doctor to learn that there is a culture of fear. Nearly every doctor knows someone who has tried to speak out against something that has happened. People know that if they do that, there will be counter-allegations against them. The groaning and expressions of surprise from Opposition Members are very sad, because it reveals just how little they were actually talking to clinicians on the ground who have been complaining about this for a decade. I received an e-mail from the spouse of a clinician who said that over the past 15 years the management styles encouraged by the previous Government had made that clinician ill.

Dr Lee: Of course my hon. Friend is right.

Rosie Cooper: Will the hon. Gentleman give way?

Dr Lee: I must get on, I am afraid. I do apologise.

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The point I am trying to make is that a certain culture prevails, and into that culture, or environment, the last Administration introduced targets. I do not suggest for one second that the last Administration thought those targets would lead to the type of care that was provided at Mid Staffordshire, but I am not surprised that there were adverse consequences, and I think Opposition Members should reflect on that.

The final thing that I want to say about culture and competence concerns politicians. The right hon. Member for Leigh said that I would not want politicians to interfere in day-to-day care. Of course I would not, but I would like politicians to take responsibility for the service. Let me give an example. There are only about 250 acute trusts in the country, and not that many mortality figures have to be looked at in each trust. It could be done on a monthly basis. However, I am told that it was not done by Secretaries of State in the last Administration. Why? If I were the Secretary of State, the one thing I would want to look at would be clinical outcomes in hospitals. If that is beyond Secretaries of State, one is prompted to ask why they are in post. If those figures had been looked at earlier enough, we might not be having this debate.

Competence and the right culture are only possible with transparency. That is the most important aspect of this whole issue.

2.9 pm

Alan Johnson (Kingston upon Hull West and Hessle) (Lab): Well, there’s a man who knows all the answers!

It was four years ago on Monday when I apologised to this House on behalf of the Government and the national health service for what happened at Stafford. We had just received the report from the Healthcare Commission, and I think it is fair to say that no one with any experience of the NHS could quite believe what had gone on. The people in charge at a time when there were unprecedented resources and investment being put into the NHS had cut staffing on A and E to such an extent that a receptionist with no medical training was triage nursing in A and E.

We need a longer debate. There is nothing ostensibly wrong with the motion, and I agree with my right hon. Friend the Member for Leigh (Andy Burnham) that we should support it, but it is clear from the way it was moved and the last contribution that this is all about the blame game. If I can just quote Francis—[Interruption.] Yes, the hon. Member for Bracknell (Dr Lee) does not agree with Francis or with Ara Darzi and knows everything, and says that Francis was a Nuremberg—

Dr Lee rose

Alan Johnson: No, I am not giving way—at least not to the hon. Gentleman. I have heard enough.

This is what Francis said in paragraph 108 of his report:

“To place too much emphasis on individual blame is to risk perpetuating the illusion that removal of particular individuals is all that is necessary. That is certainly not the case here. To focus, therefore, on blame will perpetuate the cycle of defensiveness, concealment, lessons not being identified and further harm.”

So the man who knows most about what happened at Stafford hospital—and who was entrusted by this Government and their predecessors to conduct not one,

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but two, inquiries, and who in four volumes running to millions of words sets out what happened, why it happened and how it was allowed to happen—counsels against the very action that this motion appears to propose.

Francis identified who was accountable, and the Secretary of State was absolutely right: it was the chief executive, the chair and the board of the Mid Staffordshire trust. A number of clinicians are also held accountable for the appalling lapse in standards of care at Stafford. This accountability regime is set out in legislation approved by this House.

The Francis findings are consistent with those that emerged from the inquiry into the care of children receiving complex cardiac surgery at Bristol Royal infirmary between 1984 and 1995. In that case, five individuals at the hospital, including the chief executive, were the subject of adverse comments. In respect of both Bristol and Stafford, an argument was made to an inquiry that there was an extenuating failure of national policy. At Stafford, it was national targets; at Bristol, it was inadequate resources.

It is worth recalling the Bristol inquiry’s response. Sir Ian Kennedy said:

“The inadequacy in resources for PCS”—

paediatric cardiac surgery—

“at Bristol was typical of the NHS as a whole. From this, it follows that whatever went wrong at Bristol was not caused by lack of resources. Other centres laboured under the same or similar difficulties.”

We must remember that these were the days when one in every 25 patients on the cardiac waiting list died before they could be operated on, and when somebody with a serious heart condition could wait a year to see the cardiologist, three months to see the consultant and then 18 months to two years for the operation. That is why targets had to be introduced—to get a grip on this awful situation.

Mr Cash: I am astonished by the line on accountability that the right hon. Gentleman is taking. He was the Secretaryof State and I had a row with him at the time—and, indeed, with his successor—about the question of holding a proper full public inquiry under the Inquiries Act 2005. I wrote to him, too, and I did not get satisfactory answers under the guidelines laid down in the 2005 Act on the prime ministerial rules issued by the Cabinet Office.

Alan Johnson: On the question of a public inquiry, when Francis reported on his first inquiry, commissioned by my right hon. Friend the Member for Leigh, he made the point that it was about people affected being able to come and tell their story, and Francis said in his first report:

“I am confident that many of the witnesses who have assisted the inquiry in written or oral evidence would not have done so had the inquiry been conducted in public.”

It is very important that that first inquiry allowed people to come forward. The right hon. Member for South Cambridgeshire (Mr Lansley) may also well have been right to make the second stage of that a public inquiry, which was authorised because of one of the Francis recommendations, because we now have all the information, provided before a Queen’s counsel, about what happened there.

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Francis is very clear about no blame being apportioned to any Minister. It is of course right for Ministers to be accountable if anyone knew what was going on and did nothing to stop it, or if something that was going on was a result of a Government edict or policy, but that was not the case at Stafford.

Targets had to be introduced to get a grip on this terrible situation of lack of access to health care. Targets did not cost lives; they helped to save lives. They were accompanied by the resources, the capacity and the political will that transformed waiting lists of 18 months to two years to a maximum of 18 weeks and an average of nine.

This is what Francis said about targets:

“It is important to make clear that it is not suggested that properly designed targets, appropriately monitored cannot provide considerable benefits and serve a useful purpose…indeed the inquiry accepts that they can be an important part of the health system in which the democratically elected Government of the day sets its expectations of providers who are funded by the taxpayer.”

The right hon. Member for Charnwood (Mr Dorrell) was absolutely right to say that long waiting lists have dogged the NHS since it was created in 1948. Rudolf Klein, the great historian of the NHS, says every Health Secretary shouted their orders from the bridge and the crew carried on regardless. Something had to be done to deal with that, and it was done.

Mr Jeremy Hunt: Does the right hon. Gentleman not accept that the issue was not targets, but the failure to put in place safeguards to stop managers twisting a targets culture into a culture of targets at any cost? That was the fundamental policy mistake. The lack of those safeguards meant Mid Staffs could happen.

Alan Johnson: The Secretary of State is right. Of course there need to be safeguards to ensure any system has a backstop to stop people misusing targets. The guidance from the Department of Health was very clear. In no way must the pursuance of targets interfere with the need for good patient care. The Stafford chief executive must have translated that into saying it was fine to put receptionists on triage nursing. With all due respect to the Secretary of State, I do not think that he or any of his successors or predecessors can make regulations to meet every eventuality, including for someone like that chief executive of the Mid Staffs trust.

Charlotte Leslie: In some ways I agree with the right hon. Gentleman, in that I think targets and ensuring that things are happening is not the main cause of what went wrong. Does he agree, however, that targets along with what many medical professionals criticise as the de-professionalising of the work force through the consultant contract, the working time directive and the new deal was a toxic combination?

Alan Johnson: The principal point about targets is that they reduced waiting list times. They changed a situation in which people were dying while on waiting lists, which was a disgrace in a civilised country like ours.

The Francis report also gives no comfort to those who expected him to offer up Sir David Nicholson’s head on a plate. The irony is that they choose to make this attack on an NHS that is learning the lessons of

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Stafford and an individual, Sir David Nicholson, who has done more than anyone to make quality of care the organising principle of the NHS. I, like my three successors as Health Secretary, consider Sir David to be part of the solution, rather than part of the problem He is not perfect—none of us is—but he is a good public servant who is committed to the NHS, its patients and staff. If he knew what was going on at Stafford, or colluded in the awful events there, or if any of his edicts, policies or pronouncements were in any way responsible for what happened, I would agree with his detractors. No one knew what was going on at Stafford; not even the press, who pride themselves on fearlessly exposing wrongdoing. Not a single question was raised by local MPs in this House about what was happening at Stafford, and Francis has something to say about the way they passed on complaints.

Mr Cash: Will the right hon. Gentleman give way?

Alan Johnson: No, and I read the hon. Gentleman’s correspondence and it in no way drew attention to what was happening at Stafford.

Mr Cash rose

Mr Deputy Speaker (Mr Nigel Evans): Order. Please resume your seat, Mr Cash.

2.19 pm

John Pugh (Southport) (LD): I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on calling for this debate, which I want to widen and, I hope, put on a more consensual footing.

I have a constituent whose grown-up son tragically died of leukaemia some time ago. He went to the doctor many times and was diagnosed as a young, healthy man with glandular fever. A blood test was made far too late, and he died. After the funeral, the mortified doctor wrote to the parents and apologised frankly for her failure and her error. There was no litigation or talk of system failure; there was simply a frank admission of individual human error and a sincere apology, which was accepted.

In many cases of NHS failure, there is no one individual to blame, so people talk of systems and cultures, which we have talked about constantly today. No one individual can be held entirely to blame for the system, so it always seems that no one person is to blame or is prepared to take the blame—even those who manage and design the system, such as Sir David Nicholson.

When a hospital performs badly, and the one in Mid Staffs is simply the most telling example, some of the reasons lie in external factors: in the targets imposed on it, in the requirements made of it—becoming a foundation trust is one it could have done without—and in directions that impaired it. The NHS reorganisation certainly got in the way, according to Francis. When outcomes are poor, it can be hard to determine exactly how to apportion blame and responsibility. Do we blame those who witnessed what went on and did nothing; those who failed to notice worrying trends; those who did notice them but covered them up; or those who could have intervened from on high but did nothing? In one sense, they are all

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responsible—and some are more responsible than others. But we live in a very harsh and judgmental climate, as was said earlier, and we forget that people at every stage have mixed motives—good and bad—for not kicking up a fuss, for covering up, for not intervening. Some are good—usually, they are bad—but in most cases institutional or personal reasons outweigh the concern for patients. There are quite legitimate fears that the hospital or branch will be criticised or seen as underperforming, which will be bad for morale in hospital, or that one’s career will be in jeopardy—a legitimate concern—or that one is getting a colleague into trouble. Institutional or personal goals get separated from the avowed patient-centred mission of the NHS. Frankly, that is all too human an outcome, and it has always happened to some extent. The NHS is full of very good people, but it is not yet staffed by saints. All of us at some time cover up for colleagues.

However, we always try to find in an institution a way of correcting for this, which is why we have professional standards in the medical profession and an NHS constitution. It is why we need true accountability, good complaint-handling, protection for whistleblowers, duty of candour, the learning of lessons and, of course, proper redress. That is why we have had legislation on the NHS constitution and increased democratic scrutiny, introduced by both Governments, which I applaud. I am not entirely certain what has happened to the NHS redress Bill, but I applaud that too.

However, we build other sorts of incentives into the system, and it is as well to record them. They appeal to a different aspect of human nature, a more selfish side, perhaps out of realism, perhaps because of an ideological conviction that that is how people work. We model hospitals on profit-making institutions. We make survival dependent on competition with other profit-making institutions, which have gagging clauses in their contracts for good reasons—their competitors. We try to modify clinician behaviour not always by appealing to clinical judgment, but by appealing to the pocket. Therefore, we should not be surprised if the moral atmosphere, at times, becomes a little cloudy. We, as legislators, are partly responsible for that.

If we turn the NHS into a set of businesses united by a corporate brand, should we be surprised if occasionally, individual branches put their interests ahead of those of their patients, choosing to satisfy those who pay—the Government—rather than the patients they serve?

There are many good things that we can do and would wish to do. We can make the complaints process easier. We can assign accountability better, so that an individual’s job and survival in an organisation depends on serving the patient, not on always doing what the institution necessarily requires. We can ban gagging orders, and I applaud the Secretary of State’s move in that direction. We can improve inspection, not by making it more ferocious—we do not need to do that—but by linking it better to improvement. Above all, we need to start thinking about what we want the NHS to be. If we are unhappy with the culture, exactly what sort do we want to have? Do we want the moral enterprise that Bevan envisaged—a contract on behalf of the hale and hearty, to protect the sick and vulnerable—or a set of businesses that sink or swim depending on how good they are at getting state funding? We can either rediscover the moral purpose of the NHS, or regard it as an

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organisation that brings to book from time to time the businesses that work within it, independently of the Secretary of State.

Frankly, I know which I prefer, but I have to record that currently we exist in a strange kind of moral limbo. We are judging an institution that looks very different from the original NHS, according to the high standards and moral mission Bevan set. I have a lot of sympathy with the remarks of Harry Cayton of the Professional Standards Authority, who said in The Times only this week that the NHS must rediscover its “moral purpose”. We exist in a kind of moral fog, a state of limbo, and if we want to know who is accountable for that, it is us.

2.26 pm

Jim Dowd (Lewisham West and Penge) (Lab): It is a pleasure to follow the hon. Member for Southport (John Pugh), who always makes thoughtful contributions.

I congratulate those Members who tabled this motion, to which I was happy to add my name. I am grateful to the Backbench Business Committee for agreeing to this debate, but, like others, I feel that the issue is so important that it should be debated in Government time. However, I suspect that, in the light of developments, we have not heard the last of the issues raised by the Francis report. The Secretary of State outlined a few of the measures he is intending to bring before the House, so we will have opportunities for other such debates.

I will not refer in any great detail to the Mid Staffs fiasco, serious though that is, and the obvious implications for other areas across the country. I want to concentrate on transparency, and to avail the House of the experience in south-east London of the tender mercies of the first, and so far only, trust special administrator, who was appointed to the trust next door to Lewisham—the South London Healthcare NHS Trust. That trust comprises the Princess Royal University hospital, in Orpington; the Queen Elizabeth hospital, in Greenwich; Queen Mary’s hospital, in Sidcup; and the Orpington hospital—although that was actually subject to a separate consultation.

The then Secretary of State said in a statement on 12 July last year:

“I wish to inform the House that I have made an order to appoint a trust special administrator to South London Healthcare NHS Trust…The regime, included by the last Government in the Health Act 2009, offers a time-limited and transparent framework to provide a rapid resolution to the problems within a significantly challenged NHS trust”—

trust, singular. He continued:

“The trust special administrator’s regime is not a day-to-day performance management tool for the NHS or a back-door approach to reconfiguration.”—[Official Report, 12 July 2012; Vol. 548, c. 47-48 WS.]

On 13 July, he issued the order to give effect to those measures.

I raise this as a transparency issue because the trust special administrator brought forward proposals that damage, downgrade, devastate, destroy—whichever word one wants to use—Lewisham hospital, which is a completely separate trust. The right hon. Member for Charnwood (Mr Dorrell), who is the Chair of the Health Committee and has great knowledge and experience of these matters, said that accountability and transparency are interlinked: we cannot have one without the other. I agree with him wholeheartedly, but that has not been

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the experience of the people in Lewisham: the TSA is entirely unaccountable. The TSA stands at the head of a disgraceful, disreputable conspiracy—launched in the Department of Health, aided and abetted by NHS London and handled in the most autocratic manner—to downgrade Lewisham hospital.

The titles of both the orders issued by the Secretary of State, copies of which I have here, start with the words:

“The South London Healthcare National Health Service Trust”.

The order setting up the administrator states:

“That draft report to the Secretary of State must state the action which the trust special administrator recommends the Secretary of State should take in relation to the South London Healthcare National Health Service Trust.”

It contains no mention of anybody else, yet the Department now says, “Of course we needed to look at the whole of south London and the whole of the health economy of south-east London, because everything connects to everything else.” Well, that is true of everything in the whole wide world.

From day one, all the documents of the TSA included the phrase “Securing sustainable NHS services”. One such document was headed: “Securing sustainable NHS services—Consultation on the Trust Special Administrator’s draft report for South London Healthcare NHS Trust and the NHS in south east London”. This House did not give the administrator that authority—the law does not provide for the administrator to look at the situation across south-east London—and he has acted beyond his powers.

I come now to the most interesting thing, and I accept that the current Secretary of State has had this matter dropped in his lap. If this was always about the whole of south-east London, why when the former Secretary of State had a meeting in July to discuss this did he invite the Members who represented Bromley, Bexley and Greenwich—rightly, because they cover the South London Healthcare NHS Trust area—and the Members for Lewisham? One could say that it was because they were looking more widely. Of course that is so, but he did not invite the Members representing Lambeth or Southwark. However, when we met this Secretary of State in January, after the TSA’s final report had been published, the Members for Lambeth and Southwark were included; we were told that this was a south London-wide issue. The reason for the discrepancy is obvious: they knew what they wanted to do. They wanted to get an old plan that NHS London had fostered to try to get Lewisham hospital closed. That took place under a proper clinical review under “A picture of health” four years ago, which concluded that Lewisham hospital deserved to survive and that the services it provided for the people of Lewisham should continue.

Some 10,000 people marched in November to oppose the proposals. When the final report came out, 25,000 people marched because of the outrageous actions of this administrator and the activities he has undertaken. The manner in which he dealt with the consultations was dismissive, disdainful and high-handed. Whether the objections were from members of the public, GPs or other clinicians, he behaved in line with the instructions from his bosses, which were simply to close Lewisham hospital. The people of Lewisham will not stand for it.

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2.33 pm

Jeremy Lefroy (Stafford) (Con): I wish to thank my hon. Friend the Member for Bristol North West (Charlotte Leslie) and the Backbench Business Committee for calling this debate. I particularly wish to remember all those in my constituency and elsewhere, and their loved ones, who suffered so grievously. I wish to pay tribute to those here today who campaigned to bring these things to light. I also thank the Prime Minister, the Secretary of State and all other hon. Members for their response to the report a month or so ago.

One of the main thrusts of the Francis report is to:

“Ensure openness, transparency and candour throughout the system about matters of concern”.

This is not the time to debate the Francis report fully—it was commissioned by the Government and it needs full and prompt consideration in Government time—but it is the time to say that the Francis report is of great importance. Mr Francis rightly dismisses the arguments of those who claimed at the time that the inquiry was unnecessary because Stafford hospital was a solitary exception—it was not. It may have been considerably worse than other places, but appalling standards of care have been revealed elsewhere.

The public inquiry has revealed complacency throughout the NHS and beyond; report after report detailed major concerns, which were either ignored or passed to others to deal with. What lay behind that? Perhaps it was a lack of willingness to shout and continue to shout for help when it was needed; or perhaps it was more often a fear of the consequences—the loss of one’s job or the removal of services from the local community.

Even just last week, when, as the shadow Secretary of State rightly said, a report to Monitor suggested removing most emergency, acute and maternity services from Stafford—something my constituents and I strongly oppose for reasons I set out in the House last week—there were those blaming Julie Bailey for the proposals. That comes on top of disgraceful threats—even death threats—that she has received over her work in revealing what Robert Francis, who should know if anyone does, calls the “disaster at Stafford Hospital”.

Let me make it clear that the proposals in the Monitor report are, in the main, a consequence of the financial and clinical pressures that all acute trusts, particularly the smaller ones, are facing. Stafford’s circumstances have done a little to hasten changes, but what happens at Stafford now will face all other such trusts in the coming years. That it is why it is so important that Monitor and the Secretary of State come to a good solution for Stafford, and indeed Cannock, and I will continue to work with them and with my hon. Friends on that. Nobody should take from the Monitor report the message that whistleblowing or more transparency will result in threats to their local services. Indeed, Monitor would be acting contrary to section 62 of the Health and Social Care Act 2012 if it acted in such a manner.

Let me raise another, perhaps more justified, fear of the unintended consequences of transparency. Only this week, I heard of a case where a patient could have a life-saving operation, but his chances of surviving it are only 50:50, yet without an operation he will die. Some surgeons are, even now, reluctant to take on the operation because if the patient dies, it will be counted against them in their personal mortality statistics. That is an

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unintended consequence of transparency, so transparency has to be balanced with understanding the context; otherwise, we will end up with a risk aversion that is so great that patients will suffer.

Transparency can also thrive only in a culture that is not led by blame. One of the doctors who gave evidence to Francis said:

“There was a blame-led culture, the culture being that problems had to be fixed or nursing jobs would be lost.”

How can we persuade the most suitable people to take up vital, often voluntary, roles on trust boards if their attempts to raise problems are met by blame or indifference? As my hon. Friend the Member for Southport (John Pugh) said, transparency must start right here in Parliament. He spoke movingly about moral purpose, and I agree with what he said.

Dr Thérèse Coffey (Suffolk Coastal) (Con): I agree that we do not want to deter people from becoming board members, but surely my hon. Friend must agree that if things are still going wrong and the board is not holding the chief executive and the leadership to account, its members’ positions should be questioned.

Jeremy Lefroy: I would never disagree with that. I entirely agree with what my hon. Friend says, but there is a danger that there will be so much adverse scrutiny that people will be afraid to come forward. We must challenge that and say, “You have every right, as a board member, to raise whatever you want, whenever you want.”

As I was saying, we need a proper debate here in Parliament on health care in this country, one not constrained by party dogma or blind nostalgia. It is up to us to have that debate and, as a result, give clear direction, rather than simply to react to whatever is thrown at us. We need to debate, for instance, the nonsense of pretending that it is entirely the responsibility of local trusts to deliver. So much is out of their control, be it per-patient funding, which is still far too variable, clinical standards, which are set almost in a vacuum by the royal colleges, or the impact of the European working time directive on costs, rotas and training. We need to debate the impact of the large number of specialisations in the UK—we have 61 as against Norway’s 30—which is driving up costs and driving out vital general medical and surgical expertise. We need to debate emergency and acute tariffs, which have, for many years, meant that hospitals around the country are squeezed and face forced reconfigurations that may not be in the best interests of patients.

Robert Francis also says that one of the main principles is to:

“Make all those who provide care for patients—individuals and organisations—properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service.”

He also says:

“There must be a proper degree of accountability for senior managers and leaders.”

Accountability was sorely lacking at Mid Staffs. There were attempts to see that responsibility stopped with the board. As I have already said, that is based on the fiction that it is somehow entirely in control of its own destiny. It is not. That does not absolve the board or management, but the responsibility is shared by those

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who determine so much of the environment in which they operate, including us here. Professional organisations, for instance, have procedures that make it difficult to dismiss staff who are unsuitable. The Government signed up to the working time directive without preparing for the financial and manpower consequences. And for managers, and indeed politicians, targets became more important than care itself. Again, that is our responsibility.

I have already said how strongly I oppose the blame culture, and I am not going to start blaming, but accountability involves responsibility, and far too few people have taken sufficient responsibility in this case. We must reflect and they must reflect on the message that that sends.

Too many inquiries have been left to gather dust on Department shelves, and not just the Department of Health. I and my hon. Friends the Members for Cannock Chase (Mr Burley), for South Staffordshire (Gavin Williamson), Stone (Mr Cash) and Members further afield, all of whom are affected, will not allow this one to gather dust.

2.41 pm

Valerie Vaz (Walsall South) (Lab): It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy) and to pay tribute to him for the dignified way in which he has represented his constituency during the Francis report.

I begin by thanking the Backbench Business Committee for securing this important debate. The NHS in England has a budget of £108 billion and employs 1.35 million people, with just under half of them clinically qualified, so it is right that accountability is at the centre of the NHS, for the people who work there, those who use it and those who fund it. I am sure that all my hon. Friends who have spoken and will be speaking in this debate do not see it as a chance to score political points or as background noise to denigrate an institution that was set up with the simple promise that is delivered every single day—that health care is free to everyone, irrespective of their ability to pay or of pre-existing conditions. It still operates as a service in which people are not judged on their illness but provided with a service.

I know that the debate is taking place against the background of the Francis report, but I wish to point hon. Members to a book that is about to come out—it is by Roger Taylor and called “God bless the NHS”. It was serialised in The Guardian last weekend. Roger Taylor says in the book:

“Paul Woodmansey was a senior doctor at Stafford throughout the period that things went wrong; He is mentioned by a number of patients for whom his department provided a haven of professional high quality care while standards in other wards collapsed.”

Let us not forget then that, even when a light is shone in a corner of the NHS where it is found to have failed the very people it was meant to help, there are areas of good practice.

Let us look at the background of this debate on accountability.

Jeremy Lefroy: I am sorry to interrupt the hon. Lady, but I would like to point out that the same Dr Woodmansey has been appointed as the new medical director of the Mid Staffs trust Stafford hospital. I welcome that, for the reasons that she has articulated.

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Valerie Vaz: Let us look at what is going to happen in 18 days’ time when the Health And Social Care Act 2012 comes into force. I do not want to rerun the arguments about the Act, but let us look at what is to come. Let us look at the accountability of the structures under the Act. The NHS Commissioning Board becomes the conduit for everything, including the flow of money, and all the strategic decisions filter down. If anyone cares to look at the Department of Health website and the new structure, they will see a series of concentric circles. Parliament, the Department and the Secretary of State all appear to be in the outer circle, running round in circles. Where is the accountability in that?

I have to tell the Secretary of State—although I am pleased to see him here, this is a Back-Bench business debate—that section 75 regulations were signed off, under a negative resolution, by a Minister who is not accountable to the House. Section 75 says that everything has to be tendered except for technical reasons, or reasons of extreme urgency. That had to be changed to state that contracts can be tendered if the relevant body is satisfied that the services to which the contract related are capable of being provided only by that provider.

Regulation 10 previously said that commissioners may not engage in anti-competitive behaviour; otherwise, Monitor will be after them. Sorry, those are my words. That was changed to say that commissioners must not be anti-competitive unless it is in the interests of patients.

What of the future? I pay tribute to the right hon. Member for Charnwood (Mr Dorrell), who made an excellent speech. I want to draw attention to a report that our Select Committee produced on complaints and litigation in June 2011. I urge the Secretary of State, if he cares to listen, to read that report and consider all the recommendations. Even then, we called for all providers to have a duty of candour to patients. We also said that we found it striking that the Government did not mention complaints in the information revolution consultation and were surprised that they did not see how complaints information could help people see what is going on. My hon. Friend the Member for West Lancashire (Rosie Cooper), who is no longer in her place, was right to say that complaints can provide information about what needs to be put right.

Mr Deputy Speaker, I am not sure whether you are aware that the NHS litigation bill has now reached £1.3 billion. I urge the Secretary of State to look into the reasons why that is happening. We have to redress negligence, but there are other reasons why that bill is rising. There are remedies that do not involve money or changes in structures or reorganisations.

John Pugh: Does the hon. Lady acknowledge that that is what the NHS Redress Act 2006 was supposed to do? I am genuinely puzzled, and I hope that the Minister will resolve this puzzle for me, about how much of that Act has been formally enacted.

Valerie Vaz: I cannot answer that; I am not on the Front Bench.

We all agree that there is no place for gagging clauses if lessons are to be learned about patient care. I agree that the Government have made an important announcement today, but let me remind the Secretary of State that the NHS issued management directions in 1999 and 2004. I am concerned that the NHS still needs

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reminding about these gagging clauses. We must get away from a system in which whistleblowers are driven out of their jobs on spurious disciplinary issues. At Mid Staffs, doctors and nurses are under disciplinary reviews, but as yet I have not heard anything about whether managers will also be held to account.

Action plans that arise from complaints are a vital part of organisational learning, but they are only of value if they are followed through to implementation, and it was clear from evidence to us in the Select Committee that that did not happen at Mid Staffs.

Publication of complaints data must be obligatory for all care providers, including foundation trusts and private providers with NHS contracts. We must move away, as the hon. Member for Southport (John Pugh) said, from the blame and victim culture and reduce the emphasis on disciplinary procedures. We must put more emphasis on retraining and risk management.

We should enshrine accountability for patients at board level, making boards more diverse, not just comprising the usual suspects. Private providers, as my right hon. Friend the Member for Leigh (Andy Burnham) said, are not subject to FOI; they must be. The register of GPs’ interests must be open to clinical commissioning groups. It should not be up to the public to ask whether GPs have declared their interests. Every decision must be associated with a list of GPs’ interests.

I have spoken to the chief executive of the Royal Orthopaedic hospital, who said that he ensures that doctors, nurses and managers are all on an equal footing, which is an example of good practice. His phrase is that there should be “no gap between board and ward”. He puts his patient groups on the board, every ward gets rolling visits and board members even feed the patients.

In my own way, I have also been accountable and I have published on my website a table of all the complaints my constituents have come to me about so that they can see what sort of things are going on at the Manor hospital. The chief executive of the hospital is undertaking a patient survey and ensures that he looks at all the responses.

I hope that I have outlined some positive aspects as a way of moving forward and that we will continue to have an accountable, transparent and unique NHS that is the best in the world.

2.49 pm

Mr William Cash (Stone) (Con): I believe strongly that we must not only look back properly at what happened at Stafford hospital but look forward. We must learn the lessons and we must ensure that what happens in future does not lead to the trauma experienced by the victims and patients in my constituency and those of my hon. Friends the Members for Stafford (Jeremy Lefroy) and for Cannock Chase (Mr Burley).

This is a debate about accountability and transparency and, as others have said, we also need a debate in Government time on the Floor of the House on the Francis report. On the question of accountability and transparency, I want to start with an issue that has not yet been properly considered in the debate: the role of the Secretary of State under national health legislation. Section 1 of such legislation clearly states the duties

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of the Secretary of State, and always has done. I was astonished, as I made clear at the time, when the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) left out that part of the question of accountability.

I have been involved in the history of this case. As the Member of Parliament for Stafford from 1984 to 1997 and the Member of Parliament for Stone from 1997 to the present day, I have had many constituents, including Debra Hazeldine, a prominent member of Cure the NHS, who have played an important role in drawing attention to these matters. I have worked closely with them over the whole of this period.

Contrary to what the right hon. Member for Kingston upon Hull West and Hessle said—I imagine it must have been a serious slip of memory—I wrote letters to him. Ministerial guidelines from 2005, issued by the Cabinet Office, set out in great deal what must happen when a Member of Parliament writes to a Secretary of State. He must receive a personal reply. I do not need to go into the full details now, but only the other day I asked the Minister for the Cabinet Office and Paymaster General to reaffirm the contents of those guidelines, which are still applicable.

There are only 650 of us, and serious matters can arise from the complaints we make. I am talking not about the complaints procedure of the national health service but about a Member of Parliament going to the Secretary of State to raise a specific question, usually enclosing correspondence from a constituent, and asking for action. In my case, I said that the matters I raised were both serious and urgent and that they required the personal attention of the Secretary of State. I have not the time to go into the detail, but successive Secretaries of State simply did not take the kind of action that I would have expected following those letters.

Alan Johnson: This is a fascinating subject and I am willing to have a look at any correspondence between the hon. Gentleman and me when I was Health Secretary. I certainly tried very hard to correspond with all Members of Parliament. Does he accept what Francis said:

“Local MPs received feedback and concerns about the Trust. However, these were largely just passed on to others without follow up or analysis of their cumulative implications…They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare”?

We all have lessons to learn from the Francis report; does he accept that he has lessons to learn, too?

Mr Cash: We all have lessons to learn about all matters relating to these questions, but the guidelines also talk about the necessity of chasing and following up in the Department. It is probably a question of the correspondence unit in the Department and the private office. There was a failure and the Francis report made it absolutely clear that the guidelines were not complied with and were not operated effectively. I am sure that the right hon. Gentleman, on reflection, will recall that that was what the report said.

I referred to these matters in my witness statement, and Una O’Brien, the permanent secretary at the Department of Health, also made it clear in her evidence that if such letters were received now, they would receive an immediate response, irrespective of whether the hospital was a foundation trust or not. The bottom line is that

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there was a failure within the Department and by successive Secretaries of State. The shadow Secretary of State acknowledged in his evidence that he looked at these letters. I will not dispute that. However, not only were the matters not dealt with satisfactorily, but I cannot absolve the Secretaries of State from their failure to agree to the 2005 Act inquiry.

I do not need to rehearse the history of the case. I asked not once, not twice, but repeatedly, and I had to urge and persuade the shadow Secretary of State at the time and also—I am glad that, to his great credit, he decided to do so—the present Prime Minister who, as Leader of the Opposition, decided in the light of my representations and no doubt those of others to have the 2005 Act inquiry. Without that we would not be discussing the Francis inquiry—the present one, not the previous one, important though that was—and the others. They were Government inquiries, but they did not do the job in the way the present inquiry did.

Andy Burnham: I am listening carefully to what the hon. Gentleman is saying. It is not strictly true to say that that was a Government inquiry. I brought in Robert Francis—will he acknowledge that?—in July 2009 to conduct an independent inquiry. As my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) said, in presenting his findings Robert Francis said that he felt that more people had come forward because of the nature of that inquiry.

Mr Cash: I will let the matter rest at that point for the present purpose.

I move on to the next question of accountability, with respect to Sir David Nicholson. I referred to Sir David in a number of debates way back as far as 2009. I also referred to him in my evidence to the Health Committee, in my witness statement and in correspondence with the Francis inquiry. In my judgment, for the reasons that I have already given, there was a systems failure with respect to this whole terrible tragedy, not only in relation to Mid Staffordshire, but more generally.

We need to turn a new page. I am not saying that Sir David should receive a P45 now. What I am saying is that, sooner rather than later, it is essential that he departs his post. I disagree with the Secretary of State and therefore also, I admit, with the Prime Minister on this matter, and so do many others. Accountability must mean what it says, and in this context it means carrying the can. The whole saga took place on Sir David’s watch, even though he was not at West Midlands for more than a certain time, and the problems that have arisen carry with them issues of accountability.

I acknowledge that Robert Francis referred to scapegoats. It is not, as has been said before and I repeat, a question of blaming scapegoats. It is a question of responsibility and where it lies at the time. In my judgment it did not lie only with the Secretaries of State of the time. In fairness, they have apologised.

I conclude with a statement made by David Nicholson at a conference that took place a few months ago. He made it clear in that statement that he took personal responsibility for what had happened. It is very important that we recognise that he has apologised and that he has made a statement that is clearly an admission that he

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lost the plot when, as he put it, ward 10 in Mid Staffs was under severe stress. That is the problem and I believe he has to go.

2.59 pm

Ann Clwyd (Cynon Valley) (Lab): I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on securing this debate. It is with great regret that I continue to speak about issues of abuse and neglect in our national health service. As of now, I have personally received more than 2,000 e-mails and letters. The letters continue to come every day; I want to mention just a few. All who have sent them want their stories to be heard.

The first letter says:

“My mother died in August this year”—

that is, last year.

“I still feel so angry about her treatment. She caught a hospital-acquired infection that certainly contributed to her untimely death. The lack of care and compassion that I saw horrified me. Oh yes, the boxes were all ticked. Water jug, food, medication. And all left out of reach. A nappy put on her because they couldn’t be bothered to answer her calls for assistance to the toilet. A proud and dignified mother left to sit in her own vomit. I haven’t put my complaints in writing to the hospital, as it’s not going to change anything. But maybe writing to you will help. I need my voice to be heard.”

The second letter says:

“Our Dad died in January last year. His death was quite unexpected by us as he was an active, cheerful pensioner, who went into hospital in October 2012 to have a knee operation. Unfortunately, whilst in there, his condition deteriorated, he also acquired hospital-acquired pneumonia and died. Throughout his stay in hospital his family visited him regularly and our experiences were very similar to yours. We found it very difficult to find any staff to talk to or to help him and our Dad told us about all kinds of mistreatment, neglect and mistakes that he was having to endure. Unfortunately, although normally a strong character, he also became afraid of some of the staff, who appeared to be bullying him, but he was absolutely adamant that he did not want us to mention any of his mistreatment to anyone as he was convinced that, once we left, these staff would then treat him even more badly. So we found ourselves in an impossible position, watching our Dad deteriorate before us—he had stopped eating—and hearing shocking accounts of his ‘care’ where he refused to give us any names, and yet feeling quite powerless and unable to speak to anyone about this.

Of course, at this stage, we did not know that he was going to die and we were just counting the days till we could get him out of there, but that never happened in the end.”

I have a third case:

“My memories of my father’s treatment in hospital are still so raw. He, like so many others who have suffered under the ‘care’ of NHS staff, was a man who had shown such bravery in the war (he was a veterinary officer in the Chindits in Burma, behind the Japanese lines) and in his life after, he was a true gentleman and would do anything for others, and he would not complain. He had faced death many times and through his bravery had survived against all odds, but in the end his death was to be hastened because of hospital-acquired infections, and from care bordering on neglect. Tragically he died sad and utterly disillusioned. He simply could not believe that medical staff, including consultants, could treat him and others as they did. He had placed utmost trust in them, and most of them could not care less. He looked at me one day, with utter anguish and despair in his face, and in great pain, and said, ‘Oh Annie, I would never have treated any of my animals in this way.’”

The next letter says:

“My husband of 84 underwent extensive tests to determine the reason for his illness, which didn’t manifest itself until the pancreatic cancer which had remained undiagnosed spread to his bladder. During all this time my main concern was the lack of nursing care.

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He had been shunted into a side room on his own for being ‘difficult’ and as far as I could see was simply ignored. On one visit I found him lying in his own excrement while the staff were gathered gossiping round the nurses’ station. All my requests to see a doctor were fobbed off, until one doctor mentioned casually in passing that a lump had been found on my husband’s bladder. No attempt was ever made to discuss his diagnosis with me.”

I have some shorter examples:

“I went to the nursing station on one occasion to see the entire Team bidding at the end of an eBay auction. I was kept waiting, ignored, until it was ended!”;

“first time in hospital mother had 2 broken wrists. No one would feed her when meals were delivered, despite the fact that she had 2 arms strapped up in the air! My aunt had to travel over 2 hours by bus every day just to ensure she was fed”;

“When visiting my wife… after an operation to mend her broken hip, I asked a nurse for help as she was being very, very sick. She announced ‘I am a graduate, I don’t do sick’, and left me to deal with the situation”.

As I said, I have received many letters. I have tried to acknowledge each one and respond, although obviously I cannot do so in detail. They keep coming. It is not something that pertains only in England; the same is true in Scotland, Wales and Northern Ireland. I have received similar letters for all parts of the United Kingdom.

3.5 pm

Mr Aidan Burley (Cannock Chase) (Con): May I thank the right hon. Member for Cynon Valley (Ann Clwyd) and say how sobering it was to listen to those stories? I join my hon. Friend the Member for Stafford (Jeremy Lefroy) in paying tribute to the families and loved ones of patients from Stafford and Cannock who had such appalling care and praise them for their strength in telling their stories. My hon. Friend and I will fight against any serious downgrading of Stafford hospital and, more importantly, from my perspective, any possible closure of Cannock hospital, which is managed by the same trust. I note that the Staffordshire Newsletter today launched its “Support Stafford Hospital” campaign, which I am sure we will both be supporting.

Today’s motion calls for accountability and transparency in the NHS. In relation to Mid Staffordshire NHS Foundation Trust, there are three areas that most need accountability and transparency: the granting of foundation trust status in 2009; the opposition to the public inquiry into what went on; and the “targets at all costs” culture. I will deal with each in turn.

We have the indignity and embarrassment of Mid Staffordshire NHS Foundation Trust being abolished by Monitor only five years after being granted that status. I want Members to think about that for a second. Only five years ago it was considered so outstanding and such an exemplar of compassionate care and sound finances that the right hon. Member for Leigh (Andy Burnham) awarded it foundation trust status on 1 February 2008.

Andy Burnham: May I just correct the hon. Gentleman? I was not a Minister in the Department of Health on 1 February 2008. Furthermore, the awarding of foundation trust status was the responsibility of Monitor, not Ministers in the Department.

Mr Burley: I believe that the right hon. Gentleman’s second point is incorrect; as I understand it, the Secretary of State—I accept that that was the right hon. Member

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for Kingston upon Hull West and Hessle (Alan Johnson)—signs off the awarding of foundation trust status. We know that he admitted to the public inquiry that he looked at just four lines of civil service evidence about foundation trust status before signing it off. Is that good enough for a Secretary of State? Why did he not look at it in more detail? Was he not really bothered? I think that was a dereliction of his duty to ensure public health in Staffordshire and that he should have the decency to apologise to the people in the Public Gallery who have come here today from my constituency and that of my hon. Friend the Member for Stafford.

Alternatively, was the foundation trust status signed off because of the culture of targets at any cost under the previous Government? Was organisational form, whatever it means, more important than patient care? We know locally that they wanted to prove that their foundation trust policy was a success, and that took priority over what it really meant for patients and their care. Members do not have to listen only to me on that point. Here is what a Mid Staffordshire NHS Foundation Trust non-executive said just this week in a public meeting in Rugeley in my constituency:

“Our problems started when they made 200 nurses redundant in 2008 to achieve an acceptable financial footing for Foundation status, but care standards slipped thereafter and by 2009 they had a £2m deficit.”

Everyone knows that huge pressure was put on David Nicholson by his political masters to have a foundation trust in the west midlands, and poor little Mid Staffordshire was the one that was forced through. In the interests of the accountability and transparency that the motion calls for, I want to hear an apology from those who forced through foundation trust status at a time when people were dying from appalling care and the trust was going bankrupt.

This is not just about politicians. If anybody is in any doubt about how ingrained the targets culture had become, let me quote from an old press release from Mid Staffordshire trust that I found, dated 3 October 2002. It has been taken off its website but is still findable if one looks around on the internet. It says, under the heading, “Babies’ Service of Remembrance”:

“A short service of Remembrance for those whose babies have died in the past few years is being held in the Pilgrim Chapel at Stafford General Hospital.”

Just seven days later, under the heading, “Good News from Mid Staffordshire General Hospitals NHS Trust”, it said that David O’Neill, the chief executive, was

“delighted to announce that the Trust has been short-listed to the last three for the National Partnership Industry Award for our Bed Management System”.

This culture is absolutely astonishing, and it simply has to change.

We have now had the public inquiry and Robert Francis has laid out in full gory detail the horrendous failings at Stafford hospital. One might have thought, given what went wrong, that there would have been cross-party support for a public inquiry, but not so. I presume that Labour Members now support the findings of the Francis inquiry. There were certainly many Labour MPs at the all-party health group meeting with Robert Francis on Tuesday, but I want to know how many of them were among the 260 Labour MPs who voted against a Commons motion calling for a public inquiry on 18 May 2009. [Interruption.] These might be

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uncomfortable facts for the right hon. Member for Kingston upon Hull West and Hessle, but let me point out that Labour Members ignored 81 requests for a full public inquiry into Mid Staffs between January 2009 and May 2010. They received 20 letters from MPs, 36 letters from members of the public and 25 letters from organisations. They ignored the families who protested outside the Department of Health for a public inquiry, including people from Cure the NHS.

The right hon. Member for Leigh, as he has said today, rejected a full public inquiry on the grounds that it would “distract the management”. He is welcome to intervene to tell me whether he now accepts that that judgment was wrong.

Andy Burnham: Will the hon. Gentleman acknowledge that I asked Robert Francis to conduct two independent inquiries into what happened? It is not the case that I was not doing anything. I made that judgment because I wanted to get to the truth of what happened while not overburdening the hospital with the job of getting better. I tried to strike that balance, and that is why I reached the judgment that I did.

Mr Burley: I will accept, as will, I think, everyone in this House, that the right hon. Gentleman has refused to answer the question again. He will not say whether that judgment was a mistake, and until he does so we cannot take what he says seriously.

The then Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle, joined in the refusal to have a full public inquiry. He said to The Birmingham Post on 19 March 2009,

“I really don’t think with the greatest respect that a public inquiry is going to take us any further forward”.

Will he intervene to tell me whether he will be writing to The Birmingham Post to tell people whether it has taken us any further forward? He can scowl across the Chamber, but I am afraid that that is no answer.

In the interests of accountability and transparency, we need to know why the Labour Government opposed a full public inquiry into Mid Staffordshire. Why were they so afraid of finding out the truth of what went on? Is it really so important to protect the reputation of the NHS as an institution rather than to protect the patients whom it serves and who ultimately pay for it?

There are now abounding claims and counter-claims about Stafford and Cannock hospitals as a result of the indignity of having our foundation trust abolished. One would have thought that having forced through foundation trust status and opposed a public inquiry, Labour locally would have some contrition, but sadly not. The Labour leader of my local council and Labour’s prospective parliamentary candidate for Cannock Chase are now teaming up to

“fight plans they feel are aimed at privatising Cannock hospital.”

The leader of the council said that he was launching a petition against being

“victims of Tory privatisation plans”.

There are no plans in the Monitor report to privatise Cannock hospital, so I want to know where the local Labour party is getting its information from. In fact, as a result of the FT status, private providers are already operating in Cannock hospital. I note that there were no protests from Labour councillors when private health

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facilities were introduced into Cannock hospital. Again in the interests of accountability and transparency in the NHS, I call on Labour Front Benchers to stop their parliamentary candidates and council leaders scaremongering among local people for political ends. They cannot fight privatisation if there are no plans to privatise anything. They cannot start a petition to save Cannock Chase hospital if the Monitor report suggests making it a centre of excellence for orthopaedic elective surgery in the west midlands. They cannot oppose a public inquiry and then welcome all of its findings. They cannot force through foundation trust status for its own sake rather than for what it will achieve for patients; and if someone does force it through and it has the reverse, perverse effect of causing appalling care, unnecessary deaths and the bankrupting of the trust and its abolishment just five years later, they should be man enough to apologise.

I agree that we need to be more accountable and transparent. That starts from the top with Secretaries of State and goes down to the bottom to the local council leaders and their parliamentary candidates.

3.15 pm

Barbara Keeley (Worsley and Eccles South) (Lab): I was appalled to read in the Francis report on the Mid Staffs inquiry the stories of the unnecessary suffering of hundreds of people and, indeed, to hear the examples given by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in this debate. Those Mid Staffs patients were let down and there was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed and fundamental rights to dignity were not respected.

Our Health Committee has taken evidence from Robert Francis, who has said that there was a failure of the NHS system

“at every level to detect and take the action patients and the public were entitled to expect.”

He has summarised his own recommendations as: fundamental and easily understood standards; openness, transparency and candour; accountability to patients and the public; enhanced training for nurses and leaders; and ever-improving measures of performance.

In the short time available, I want to focus on two areas: first, accountability or, indeed, the lack of it in our NHS structures, and secondly—this has already been touched on—the question of what is good practice on patient safety.

The Health Committee is increasingly seeing examples of a gap in accountability in the restructured NHS and I will touch on one small example that we heard this week. We had a session with senior Department of Health staff—the director of mental health, the national clinical director of mental health and the deputy director of secure mental health services—who are responsible for advising Ministers on mental health strategy, for devising mental health legislation and for clinical leadership on mental health. They did not know that patient groups were reporting cuts to community mental health services or that they lacked access to therapeutic services, with very long waits.

Alison McGovern (Wirral South) (Lab): Does my hon. Friend agree that scrutiny to make sure that the dignity of mental health patients is protected is of utmost importance?

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Barbara Keeley: Indeed. It is disturbing that the people responsible for advising Ministers on legislation are not aware of what is going on. In fact, they started by trying to tell me that they thought that community services were still expanding, as they had been up to 2010. They did not have a picture of the services. Indeed, they told us that there was no routine collection of waiting times for mental health services and they did not have data on readmissions. They did not even seem to understand the trends involved in those important issues.

The exchange left me feeling very concerned about accountability in our new NHS structures. If staff at the most senior levels of the Department of Health who are responsible for strategy and legislation have no idea what is going on in health services across the country, that is serious. The major restructuring of the NHS seems to us—this has been mentioned by fellow members of the Health Committee—to represent a decline in accountability.

We need to learn from good practice to improve patient safety, which has been touched on by my hon. Friends the Members for West Lancashire (Rosie Cooper) and for Walsall South (Valerie Vaz). A major review is taking place of the 14 hospitals with the worst mortality rates. In recent Health questions, I told the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that good practice in hospitals with low mortality rates should be investigated alongside the review of high mortality rates and poor practice in the worst-performing 14 hospitals. He did not take that point on board, so I will try again today.

I want to talk about what has been achieved at my constituency’s local hospital trust, Salford Royal NHS Foundation Trust. I visited the hospital recently in the wake of the Francis report and was impressed to hear what it has achieved over the past five or six years. It already seemed to have in place many of Robert Francis’s recommended actions, which I touched on earlier. Salford Royal has taken action on nurse staffing ratios, which my right hon. Friend the Member for Leigh (Andy Burnham) touched on; reducing MRSA infection and pressure sores; the transparency of patient information; and involving clinical staff in quality improvement.

Mr Jeremy Hunt: I completely agree with the approach that the hon. Lady is taking. One of the jobs of the new chief inspector of hospitals will be to identify the outstanding hospitals, the safest hospitals and the hospitals with the best compassionate care, so that other hospitals can learn to do the same things.

Barbara Keeley: That is very good. I hope that the Secretary of State will make that point to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, because he did not seem to appreciate it when I made it to him in Health questions.

Let me touch on what other hospitals might find if they start looking at the excellent practices at Salford Royal. I do not underestimate the importance of the terrible examples that we have heard about, but at the same time, my trust has had a quality improvement strategy since 2008, with specific projects that are aimed at reducing falls, unexpected cardiac arrests, surgical

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site infections, sepsis and other harms. Because harm tends to be caused to patients much more over the weekend—we have seen many examples of that in the cases that we have looked at—the trust has moved back to seven-day working in an attempt to achieve the same standard of care on the weekend and overnight as people receive on a weekday during working hours.

I believe that having the right nurse staffing ratios is vital to patient safety, but that issue keeps being glossed over by NHS leaders and Ministers. I have asked questions about it repeatedly in this House. Salford Royal uses a safe staffing tool to ensure that it works to safe staffing levels. There are minimum staffing requirements throughout the hospital and incident reports are completed if the ratios are not met. Each division reviews its staffing establishment every day and escalates concerns if the numbers fall below the minimum safe level. Salford Royal is a mentor site for nurse rounding which, as we have heard, means that nurses go round their patients each hour to ensure that their needs are being met.

My right hon. Friend the Member for Cynon Valley gave examples that showed the impact of hospital-acquired infections. All the work that is done to reduce MRSA and other infections is crucial. As in the other examples of flattened hierarchies that we have heard about, anyone at Salford Royal can challenge others on issues related to infection control. There is also mandatory training in aseptic non-touch techniques.

Teams design their own quality improvement projects in a clinical quality academy. There has been a specific quality improvement project over the past two years that is aimed at reducing the number of pressure ulcers. Each pressure ulcer is declared, the root causes are analysed and the patients are involved in the investigations. Nurses can monitor the positioning of patients on their hourly rounds and help to turn them if required. Those examples of good patient care can help us to get over the kinds of awful care that have been described today.

My final point is about transparency. Patients and families can check the harm data, because they are shown on a whiteboard at the entrance to every ward. The board records not only how many days it is since the last MRSA infection or pressure ulcer, but provides assessment scores on 13 fundamental nursing standards. Such public reporting to patients and families is important because it aids accountability and helps staff to feel accountable for the standards on their ward. We need that now more than ever.

Unsurprisingly, Salford Royal has achieved the highest rating in the NHS staff satisfaction survey for acute trusts in the NHS. Staff are supported to challenge existing systems and test new ideas to improve standards. I am aware of how much of a contrast that is to what we have heard this afternoon. The NHS is a system in which one area has had a catastrophic failure at all levels of patient safety, while other areas have achieved the highest standards of safety and patient care. We must look at both if we want to understand why that is.

3.24 pm

Dr Sarah Wollaston (Totnes) (Con): I want to start by thanking the vast majority of staff in the NHS, who go to work every day motivated to serve their patients and deliver world-class care.

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We should not think that we can just return to the halcyon, storm-free days of the 1970s, when NHS care was perfect. Before I started medical school, I worked as a nursing auxiliary, which would now be called a health care assistant, in what was then known as a geriatric hospital. I have no wish to return to the days of vast, mixed wards and a rather authoritarian approach to care. I would far rather the NHS of today than that of the 1970s.

However, the mantra that the NHS is the envy of the world sometimes gets in the way of providing decent feedback and criticism when things go wrong—and after listening to the words of the right hon. Member for Cynon Valley (Ann Clwyd), who could say that things do not go wrong? The failures at Mid Staffs, and the fact that more than 1,000 people died in a single hospital, are truly shocking. Robert Francis told the Health Committee that he had spent three years of his life “listening in horror”—how shocking! It is hard to imagine any other institution or organisation where death on that scale would not have led to prosecutions, yet too often in the NHS it is not prosecutions that follow but promotions, just as it was in this case.

It has, unfortunately, become something of a heresy to criticise the NHS, and my comments are not to be interpreted as criticising the vast majority of staff, but rather as a means of considering how we can help those staff and their patients. It is vital that NHS staff are free and feel safe to raise concerns. This week, at a meeting in the House that I was chairing, Robert Francis spoke about “complaints being a gift”, but that is not the experience of staff or patients within the NHS.

The Health Committee conducted an inquiry into complaints and litigation in the NHS that reported in June 2011, and I wish to read from the chilling evidence that we heard from Nicola Monte. She spoke of her experience of being barrier-nursed in Stafford, and said that a nurse came into her room and berated her saying, “I have been off sick because of you complaining about me. Do you realise the suffering you have caused me?” Too often, staff end up feeling that they are victims because—as they know—they are often scapegoated for what are system failures, often by management. That runs throughout the NHS; the response to complaints is defensive and dismissive and that must change if we are to implement what Robert Francis rightly recommends as a new culture change of openness, transparency and candour within the NHS.

I hope, however, that no one will think that introducing a statutory duty of candour can be a single approach. That will not work without a culture change that supports and welcomes complaints as a “gift” to identify problems and improve care. I hope the Government will implement in full the recommendations made by Robert Francis so that complainants are regarded not as the problem but as part of the solution.

I particularly welcome the Secretary of State’s announcement that gagging clauses are to be outlawed with immediate effect throughout the NHS but—I hope he will not mind my saying this—that must extend to the top of the system. Would the Secretary of State feel it appropriate for David Nicholson’s secretary to have the following clause in his or her contract:

“That they should avoid associating themselves with recommendations critical or embarrassing to the NHS commissioning board”?

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I think we would find that wholly unacceptable, yet, if I may refer Members to the ministerial code of conduct, the Secretary of State’s Parliamentary Private Secretary, who is not a member of the Government, has exactly that clause within his contract. That is something we have to change because the culture of the NHS must extend from the Department of Health to the nursing auxiliary—or health care assistant—at the bedside, and to patients so that they and those around them feel safe and able to raise complaints.

Mr Cash: Is my hon. Friend aware that Public Concern at Work, to which I referred in my witness statement on Stafford hospital, has played a big role in highlighting whistleblowing and has set up a commission to look at that issue? The outlawing of gagging clauses should apply not only on severance, but also—emphatically—when people are in post so that they can be properly protected when acting in the public interest.

Dr Wollaston: I absolutely agree. This is about starting to identify the culture and values of the people we employ in the NHS, and making it clear that not only does everyone in the NHS have a duty to bring forward concerns, but that those concerns will be welcomed and acted on. I would like everyone in the NHS to have an individual to whom they can go and feel safe in raising their concerns. I thank my hon. Friend for raising that point.

My hon. Friend the Member for Reading East (Mr Wilson) has told me that he does not feel that he has been gagged, which is great, but there is still an important point of principle: as a PPS, he is not able to speak in this debate. We want everyone, from the very top of the NHS and the Department of Health, right through to the bottom of the system, to feel that they are fully free to raise any concerns they have, wherever they may be.

After the Bristol heart scandal, whistleblower Stephen Bolsin was asked how we could prevent this from ever happening again. He said:

“Never lose sight of the patient.”

His whistleblowing cost him his career. He first raised the alarm in 1989. His work over six years to raise his concerns remains one of the single most important improvements in clinical outcomes in the NHS—that is how important whistleblowers are to our system. Yet the scandals keep happening. Would it not be a tragedy if, five years from now, we were still saying, “We need to put patients at the heart of everything we do in the NHS”? It is time to make that happen.

3.31 pm

Frank Dobson (Holborn and St Pancras) (Lab): I congratulate the hon. Member for Stafford (Jeremy Lefroy) on his thoughtful contribution to the debate. We all owe it to the people of Stafford and those round about, all of whom depend on Mid Staffs, to ask the Secretary of State to guarantee that nothing and no one is allowed to use the horrors that occurred as an excuse to close the hospital or to run it down. That would punish the local people, the potential patients, and the good staff at the hospital. I hope he is willing to make whatever organisational changes—extra cash, or new ways of financing parts of the health service—are necessary to make that guarantee to the people in that area.

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I started off as Health Secretary fully in favour of transparency. My last job before I became an MP was working for the local government ombudsman. It was my view, and it remains my view, that the best way to deal with anything that has gone wrong is to stand up and say, “Sorry, I got it wrong.” However, there is a problem. We are asking people in the NHS to operate in two different worlds. If something goes wrong in the hospital, the GP’s surgery or the clinic, we say: confess straight away. That is one world—the official world. People then get in their car, drive out of the car park to go home and bump into another car. What happens? Their insurer says, “Whatever you do, don’t accept any responsibility.” We need to recognise the clash of different worlds that people live in.

When the excellent hon. Member for Aldridge-Brownhills (Sir Richard Shepherd) introduced the Public Interest Disclosure Act 1998 to protect whistleblowers, I made sure that the Labour Government supported it, and that the provisions covered the national health service. There were those who did not want it to cover the NHS. I am delighted to say that I anticipated that some might want to have disappearance clauses in contracts—gagging clauses—and issued a circular that prohibited them. Any health body that has inserted such a clause is breaking the terms of the circular that was sent out in my name in 1999.

I also established the Commission for Health Improvement. It was intended to monitor and improve standards, and it was the first time in the history of the national health service that such a body had been set up. At that time, there was no machinery in the NHS for identifying good or bad practice, or for promoting good practice more widely and eliminating poor practice. I also required all health boards and chief executives to be responsible for the quality of treatment and care. No such obligation had been placed on them before, and that was a step in the right direction.

The hon. Member for Stafford rightly said that if transparency is to be based on experience and on data, those data have to be fair. We cannot have a situation in which someone who performs regular, straightforward surgery is compared favourably with someone who treats people in desperate circumstances and therefore has a greater chance of the operation or treatment going wrong. Everyone in the medical profession has got something wrong, and some have done so quite a few times.

If we are to have transparency in the provision of services to NHS patients that are paid for by public money, that transparency must apply not only to the NHS providers but to any other franchised provider of services. I know from experience that, when our lot were selling off a GP practice in my constituency, we were told that we could not find out the terms of the contract because it was commercially confidential. If we had been able to see the contract, we might have spotted that it enabled the contractor to leg it if things got difficult, which is what it duly did.

However keen Government Members might be on involving the private sector—I freely admit that I am not, but they are—they must ensure that patients and others are not denied information on the ground of commercial confidentiality. I strongly support the idea of making whistleblowing a duty, and that duty of candour

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must apply to any private sector provider. We cannot have them hiding away behind their private profit-making efforts. We must also ensure that, when anything goes wrong, the Secretary of State will answer to the House of Commons. We do not want anyone coming along and saying, “It wasn’t me, guv, it was the commissioning board wot got it wrong.” We must make it absolutely certain that our national health service is responsible to us here.

My final point is that I am sick to death of what is happening at the Whittington hospital. In order to qualify for trust status, it is being told to reduce the ratio of nurses to patients, yet it is already one of the five safest hospitals in the country.

3.38 pm

Stephen Barclay (North East Cambridgeshire) (Con): I join other Members in welcoming the Government’s announcement today of a ban on gagging clauses, but is it not surprising that we need such an announcement? The right hon. Member for Holborn and St Pancras (Frank Dobson) has just told the House that he issued guidance on this issue in 1999, and we also have the Public Interest Disclosure Act 1998 and the 2004 guidance. My right hon. Friend the Member for South Cambridgeshire (Mr Lansley) even put these conditions in the NHS constitution, and yet we find that we need an announcement on the matter today. My hon. Friend the Member for Stone (Mr Cash) has been repeatedly assured that there is no problem. I raised the issue in some detail with Sir David Nicholson in the Public Accounts Committee on a number of occasions, and I was constantly told that there was no need for change, so does Sir David agree with today’s announcement? Indeed, is a change being announced? Will the Secretary of State confirm that this announcement covers all payments, including those through judicial mediation, and will it apply retrospectively?

There seems to be a striking uniformity as between both Front-Bench teams when it comes to telling us that Sir David Nicholson is a wonderful manager, yet he did not know about the high mortality figures—even though they have been published in national newspapers since 2001; even though his own staff were logging in to the Dr Foster data; and even though the figures were high when he was the chief executive of the strategic health authority that was responsible for Mid Staffordshire. He did not know about gagging clauses when he was the accounting officer; he did not know about fixing mortality codes, yet they are now subject to police investigation. As he told the Health Select Committee, he did not know about judicial mediation—a flaw in the system, yet he is responsible for system and controls. He did not know about the Gary Walker case.

My hon. Friend the Member for Bristol North West (Charlotte Leslie) says that she has concerns about the US reports, but once again, Sir David seems not to know about them. He did not know about the Royal College of Surgeons 2007 report into Mid Staffs, which raised serious concerns, as my hon. Friend the Member for Stone is well aware, but in respect of which no action was taken. In other areas, too, we should remember that he was not just the accounting officer for the wonderfully successful NHS IT programme, but the senior responsible owner. We are told that he is a great manager, but it is difficult to see the evidence to sustain that claim.

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Mr Cash: In a conference on 4 October 2012, I understand that Sir David Nicholson said that

“the senior leadership of the NHS and I was part of it in those circumstances”

but “lost the plot”. He continued:

“We lost the reason why we were there. We got so excited about…changes”,

but he went on to acknowledge that

“on ward 10 in Mid Staffordshire Hospital really bad things were happening”.

That is the sort of admission that he had to make in those circumstances. Does my hon. Friend agree that that amounts to admitting responsibility for the system’s failure?

Stephen Barclay: I do agree with my hon. Friend, and that does seem at odds with the Government’s welcome commitment to promoting individual accountability. In response to the Robert Francis report, the Prime Minister talked about three fundamental problems with the culture of the NHS. Of course that went beyond one individual.

I am concerned about the timing of the announcement of the appointment of Barbara Hakin, a close ally of Sir David Nicholson. It is important to note that she is innocent of any allegations being made against her, but I understand that she is under investigation at the moment. The timing of the appointment, then, seems strange. I invite my right hon. Friend the Secretary of State to intervene to clarify whether he was told of Barbara Hakin’s appointment prior to it being made. If he was not told, does not that say something about the power that Sir David wields within Richmond House?.

A further issue is whether Parliament knows the quantum or scale of the payments made to whistleblowers. I have repeatedly raised this matter over the last two years and was finally given a figure of £15 million paid over three years—silencing quite a lot of people. It now emerges, however, that that is not the whole story, as it does not cover payments such as the one for Gary Walker, which was paid through judicial mediation.

As seen in the NHS manual for accounts, each NHS body or trust is required to compile a register detailing all special payments made, including those through mediation. As I understand it, even the Department of Health does not know how many such payments have been made—and that applies to the Treasury, too. In a response to my parliamentary question this Tuesday, the Minister said:

“Approval has not hitherto been required by the Chancellor or the Secretary of State for Health for special severance payments made as a result of judicial mediation. However, as of 11 March”—

this Monday—

“approval will be required.”—[Official Report, 12 March 2013; Vol. 560, c. 182W.]

The position seems to be moving as of this week. Parliament does not know how much has been paid to whistleblowers, so will the Minister clarify when we will know?

In my Adjournment debate of a week last Monday, my hon. Friend the Member for Bracknell (Dr Lee) asked whether the chief executive of Mid Staffs was subject to a gagging clause. We received a welcome reassurance that we would be given an answer, but when we were on our way to the Chamber for this debate, my

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hon. Friend told me that he had received none. I hope that the Minister will clarify whether Mr Yeates was subject to a gagging clause.

Mr Burley: Is my hon. Friend aware that Mr Yeates left in 2009 with an £80,000 pay-off and a six-figure pension lump sum before moving to a job with a charity called IMPACT Alcohol and Addition Services, based in Shropshire, and that he refused to give oral evidence to the inquiry because of a unique form of post-traumatic stress disorder? Where is his accountability?

Stephen Barclay: My hon. Friend is right. Not only did Mr Yeates leave with, I understand, a significant payout, but he went to work for a charity that was in receipt of Department of Health funds. I think that as a matter of urgency we should clarify the terms on which Mr Yeates left the NHS, what Ministers knew, and what senior officials—in particular, David Flory—were aware of at the time of his departure.

I fear that we are in danger of sending a confused message to staff and families of patients in the NHS. On the one hand we say that the culture needs to change, but on the other we say that the people who are responsible for that culture—the people who are paid significant sums to lead it—should stay.

My hon. Friend the Member for Totnes (Dr Wollaston) is absolutely right: there is much in our NHS that we should celebrate and of which we should be proud. However, we do it a disservice if we are not prepared to identify where it is going wrong, and to be transparent about the areas with high mortality and about the existing culture which has a chilling effect on those who are brave enough to speak out. Is it not informative that the one person who spoke out at the Bristol inquiry, and who did so much good, is the one person who has never worked in the NHS again?

I think that the challenge for the House today, and in subsequent weeks, is to ensure that this time it learns the lessons that were clearly not learnt then.

3.47 pm

Mr Virendra Sharma (Ealing, Southall) (Lab): Thank you, Mr. Speaker, for allowing me to speak in this important debate. I congratulate all those who made it possible.

In the light of the tragedies at Mid Staffordshire and Winterbourne View, it is clear that some of the mechanisms for ensuring accountability and transparency in the NHS must be reviewed. Safeguards need to be put in place to make our NHS more accountable. That means listening to the concerns of patients, heeding the advice of NHS staff, and ensuring that whistleblowers are correctly protected.

Patients have always been, and always should be, at the centre of the NHS. It is true, of course, that the discoveries made at Mid Staffordshire do not represent the typical experiences of NHS patients, and that nurses and doctors deliver great care for patients every day, but it should not be possible for the failings of Mid Staffordshire to be replicated. If such failures are to be prevented in future, patients’ voices must be heard, and patients must receive clear assistance and information about their treatment.

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Figures from the national cancer patient experience survey show that only 64% of patients felt they were able to discuss their concerns and fears with staff in the hospital, and that just over 50% were given information about the financial support to which they were entitled. While the survey goes a long way towards ensuring that there is more transparency, some of those figures are worrying. A large proportion of cancer patients still feel that they are not given sufficient information, or that they are unable to relay their concerns to those who are caring for them.

We welcome the creation of bodies designed to establish greater accountability to patients and the public by giving them a stronger voice in the Health and Social Care Act 2012. However, many councils across the country are still unsure whether they will have a running local HealthWatch in coming months, or have not even signed contracts with organisations to run it. These bodies are crucial in providing accountability for NHS patients; without them, the public does not have a voice.

One of the main reasons for the failings at Mid Staffs is the existence of a culture of covering up mistakes. Those who tried to speak out were bullied, hassled and silenced. It is crucial that NHS staff are allowed to voice their opinions without fear of unjust repercussions.

The previous Labour Government made huge inroads in helping NHS staff raise their concerns and in protecting their rights. These have, however, not been sufficient. I also have to commend the Secretary of State’s timely decision to ban gagging clauses in severance agreements. However, should not the Government be making it easier for NHS staff to voice their concerns while they are still in employment? We have seen many examples of consultants, doctors, nurses and other staff who spoke out about the failings of Mid Staffs and who were persecuted and struck off for doing so, and about NHS staff who felt unsupported and bullied by their supervisors to hide their concerns.

I must mention the case of Dr Narinder Kapur, one of Britain’s leading neuropsychologists and now campaigner for fairer treatment for whistleblowers. Out of his moral and ethical responsibility as a doctor, Dr Kapur alerted the NHS of certain failures he observed within his department, such as under-qualified, unsupervised staff treating patients and putting them at risk. His dismissal by the Cambridge University Hospitals NHS Foundation Trust was ruled unfair, but he still was not reinstated. This man, who was one of the best neuropsychologists in the country and was trying to help his patients and make his hospital a better place, was left penniless and lost his home.

The Government need to do more to ensure that NHS staff who blow the whistle on unethical practices do not receive the same treatment as Dr Kapur, and are protected from such persecution. Hard-working consultants, doctors, nurses and other staff who want to make the NHS a better place should not fear for their jobs and should not be bullied by their supervisors. Patients should be assured that they have recourse for complaints and that their voices will be heard. What will the Government do to protect patients and change this culture of covering up and bullying, to ensure that we do not have another Mid Staffs and to make the NHS more transparent?

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3.53 pm

Steve Baker (Wycombe) (Con): My constituent Edward Maitland was a frail man who could not eat solid food following tongue surgery. He was admitted to Wycombe hospital from his warden-controlled accommodation suffering from dehydration, shortness of breath and weight loss, things from which he should have recovered. His son, a paramedic, clearly explained on his father’s admission that Mr Maitland could not eat solid food and he also provided liquids. About three weeks later Edward Maitland had died from aspiration pneumonia. At the post-mortem, Weetabix was found in his lungs.

Of course, the investigation was taken extremely seriously and the documentation is, up to a point, very professional. Under “root cause”, it states:

“The investigation found that there is no evidence to support robust communication between nursing and medical staff…No SBAR”—

situation, background, assessment and recommendations—

“documentation was used in EMC or in handover to Ward 6B this would have highlighted the patient’s nutritional needs.”

It proceeds to make some “recommendations”, but I want to highlight the “lessons learned”:

“To care for all patients with a holistic approach and the multi-disciplinary team must focus on all health concerns.

Better communications between all staff members, this should be ongoing and involve all the different professionals who may need to collaborate the care delivery plan. This collaboration and communication should involve the patient, family and the healthcare staff.”

Unfortunately, that is bread-and-butter, typical stuff—and managerial gibberish.

What I learned is that two words would have saved the life of Edward Maitland: “no solids”, written on the records at the end of his bed, on his wristband, and above his bed. The situation in his case is very simple. A man died who ought not to have died. He should not have died in these circumstances.

I have the hard task of saying, therefore, that I look to the courts, and the Francis report helps me. Recommendation 13 of the report, on fundamental standards, refers to:

“Fundamental standards of minimum quality and safety, where non-compliance should not be tolerated. Failures leading to death or serious harm should remain offences for which prosecutions can be brought against organisations.”

Elsewhere, the report discusses at some length—I do not have time to go into detail—a regulatory gap in relation to the Health and Safety Executive:

“It should be recognised that there are cases which are so serious that criminal sanction is required, even where the facts fall short of establishing a charge of individual or corporate manslaughter. The argument that the existence of a criminal sanction inhibits candour and cooperation is not persuasive. Such sanctions have not prevented improvements in other fields of activity.”

I took legal advice. I approached a retired circuit judge in my constituency, who in turn approached a firm of lawyers. I am most grateful for the guidance of Kate McMahon, of Edmonds Marshall McMahon, who has provided me with considerable free legal advice in relation to this case. The firm specialises in private criminal prosecutions. She has explained that, at least at the preliminary stage, there may be a corporate manslaughter case to answer, and liability for gross negligence manslaughter may well be attributable to one or more employees of the hospital.

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I do not want people to be prosecuted unnecessarily, or to see taxpayers’ money wasted, but I do want accountability, and I believe that in the end the courts provide that crucial accountability. Edward Maitland’s son Gary now has this advice, and I have left it to him to decide whether to approach the police. I have briefed the police superintendent in Wycombe on the circumstances. I believe that the courts should be the ultimate way of sanctioning the NHS. Francis agrees, and I hope he will provide a policy in this area.

There should be more democratic control. I am delighted—

Frank Dobson: Does the hon. Gentleman not agree that one characteristic of involving lawyers is that there is a lot of money around, and it goes to them? Would it not be better spent trying to ensure that performance standards are enhanced, rather than employing lawyers to have a go at the people who got it wrong?

Steve Baker: Of course I would rather that the money was spent on standards and performance and not on prosecutions, because I would rather the problems did not occur. I do not wish to lecture the right hon. Gentleman, and I feel sure he did not quite mean it this way, but if we do not intend to apply the law of corporate and individual gross negligence manslaughter, let us repeal it, or amend it so that it does not apply to the NHS. I have to say to the right hon. Gentleman that it does apply to the NHS and that in certain cases, as Francis has said, things are so bad it should be applied.

I ask the Government to look at democratic control. I am delighted that the Secretary of State is reforming the Care Quality Commission, but how can we make sure that there is more direct accountability, perhaps to the health and well-being boards, and the overview and scrutiny committees? How can we give them the power to sanction or perhaps even, through due process, dismiss a board or a chief executive?

I think here of Paul Ryan, a man with vascular disease who had lost one leg already when he found himself sick. He had four days of GP visits and spent nine hours in accident and emergency on a Friday. He was then sent home, having had an MRI scan, after which he was expecting to lose his leg on the Monday. He was told to expect a phone call, but no phone call came. The Ryans eventually called 999 and were told that it was better to get a GP. The GP arrived and called an ambulance. It took two hours for that to arrive and Paul Ryan died in the ambulance with his wife on the way to hospital.

Mr Cash: Does my hon. Friend agree that accountability does reside also with the Secretary of State, as set out in the national health service legislation? That is essential in relation to our functions in this House and those of this Secretary of State and former Secretaries of State.

Steve Baker: I am grateful to my hon. Friend for his point, although it has been examined at length, so I do not want to go down that rabbit hole with him—I hope he will forgive me.

The post-mortem on Mr Ryan indicated that he probably would have suffered the same fate in any event, but the system let the Ryans down—Mrs Lyn Ryan made that point to me and to the local newspaper.

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Unfortunately, the case plays right into the fears of the public in Wycombe, because we lost our accident and emergency facility in 2005 and we recently lost our emergency medical centre. We have just had two similar repeat occurrences of the minor injuries unit failing to refer people across the car park into the excellent cardiology and stroke units. We have seen an enormous range of little problems, for example, an 85-year-old lady with dementia was sent home in a taxi at 2 am in just her hospital gown. This cannot go on, and the public’s concerns are justified. The trust is being investigated by Sir Bruce Keogh and although I have heard good reasons why its mortality levels are justified—they relate to running hospice care, in particular—this must be taken as an opportunity to improve things.

Finally, I wish to make a point on transparency. Yesterday, I spoke to Anne Eden, the chief executive of the trust. I am not going to put on the record the entire content of the conversation, but when I told her that I intended to raise this issue of corporate manslaughter on the radio this morning, I was told, in terms, “To protect the reputation of the Buckinghamshire trust, legal action would be sought.” This is a matter of public interest being raised by a Member of Parliament in good faith, but I have had to—[Interruption.] To be fair to her, she was talking about the radio. But I have had to rely on privilege to protect myself from being sued on this matter. It is not acceptable that such a matter should have to come to a Member of Parliament, simply to rely on privilege. The situation reinforces something I have experienced again and again since becoming an MP: second-hand rumours and half-truths about the state of health care in Buckinghamshire. I have encountered: people stymied; people thinking it is helpful to give half a rumour to a friend to repeat to me so that I can know how bad things are; and people’s frustration at not being able to do anything. I know that Buckinghamshire Healthcare NHS Trust is obviously close to your heart, Mr Speaker. I know that it expects to satisfy Sir Bruce Keogh, but it is really time for proper accountability and that must include the courts.

4.3 pm

Mr Andy Slaughter (Hammersmith) (Lab): Two NHS stories were leading the news this morning, both of which are relevant to the subject of this debate. The hon. Member for North East Cambridgeshire (Stephen Barclay) and my hon. Friend the Member for Ealing, Southall (Mr Sharma) have talked about the important issue of whistleblowers. I want to talk about the other subject, which is the conflicted interests of clinical commissioning group members.

All hon. Members should be grateful for the British Medical Journal report that was the basis of this morning’s new stories. In case anyone has not seen it, let me read the headline points. It states:

“More than a third of GPs on the boards of the new clinical commissioning groups (CCGs) in England have a conflict of interest resulting from directorships or shares held in private companies”.

It continues:

“conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.

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The interests range from senior directorships in local for-profit firms set up to provide services such as diagnostics, minor surgery, out of hours GP services, and pharmacy to shareholdings in large private sector health firms that provide care in conjunction with local doctors, such as Harmoni and Circle Health.

In some cases most of the GPs on the CCG governing body have financial interests in the same private healthcare provider.”

Yet the cheerleader for the privatisation, Dr Michael Dixon of NHS Alliance says:

“The priority is to move services out of hospital and into primary care. The reason this hasn’t happened to date is because of blocks in the system. It’s more important to remove those blocks than be preoccupied with conflicts of interest.”

I say that the British Medical Journal has done a good job, but it has only just scratched the surface. I shall refer to my own experience of trying to get to the bottom of this matter in north-west London.

On 10 November an article by the social affairs editor of The Guardian began:

“Five family doctors have this week become millionaires from the sale of their NHS-funded firm to one of the country’s biggest private healthcare companies in a deal that reveals how physicians can potentially profit from government policy in the new NHS.”

It went through the individual shareholdings of those doctors who had sold out to Care UK and it continued:

“Another winner seems to be NHS reform champion Ian Goodman. The north-west London GP chairs the Hillingdon clinical commissioning group and was also a board director of Harmoni. He could make as much as £2.6 million.”

John McDonnell (Hayes and Harlington) (Lab): This Dr Goodman chairs my local CCG and tried to force Hillingdon hospital to put £13 million of operations out to tender, which would have destabilised the whole hospital. I pay tribute to the Treasurer of Her Majesty’s Household, the right hon. Member for Uxbridge and South Ruislip (Mr Randall) and the Parliamentary Secretary, Cabinet Office, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), who joined me in preventing that from happening. It would have meant Hillingdon hospital being financially destabilised in the long term.

Mr Slaughter: I am grateful for that. I did a company profile for Harmoni. It revealed that, although he might have sold his shares for that amount of money, Dr Goodman is still listed as head of clinical spine. A series of press articles deals with the failings of Harmoni—failures that have caused deaths through under-staffing or poor-quality staffing—and why it is under investigation.

Let me return in the time I have available to my attempts to get to the bottom of the matter. The same day as I read the article in The Guardian, I wrote a short letter to the chief executive of the NHS in north-west London. I said:

“I attach the front page article from today’s Guardian, which you may have seen, regarding the sale of out of hours GP service provider Harmoni to Care UK. The article states that a number of GPs will make substantial sums from the sale.

I note that four of the CCG chairs in NW London declare shareholding or directorship in Harmoni, as does your Medical Director. It would be helpful to know if they are beneficiaries of the sale and by what amount.”

I then asked for assurances as to the future.