PARLIAMENTARY DEBATES - United Kingdom Parliament

1471 26 MARCH 2013 Mid Staffordshire NHS Foundation 1472
Trust
Mid Staffordshire NHS Foundation Trust
12.32 pm
The Secretary of State for Health (Mr Jeremy Hunt):
With permission, Mr Speaker, I would like to make a
statement on the Government’s response to the Mid
Staffordshire NHS Foundation Trust public inquiry.
I congratulate my predecessor, my right hon. Friend
the Member for South Cambridgeshire (Mr Lansley),
on setting up the public inquiry and on the many changes
that he made in foreseeing its likely recommendations. I
also pay tribute to Robert Francis QC for his work in
producing a seminal report that will, I believe, mark a
turning point in the history of the NHS.
Many terrible things happened at Mid Staffs, in what
has rightly been described as the NHS’s darkest hour.
Both the current and former Prime Minister have
apologised. However, when people have suffered on
such a scale and died unnecessarily, our greatest
responsibility lies not in our words, but in our actions.
Our actions must ensure that the NHS is what every
health professional and patient wants: a service that is
true to NHS values, that puts patients first, and that
treats people with dignity, respect and compassion.
The Government accept the essence of the inquiry’s
recommendations and will respond to them in full in
due course. However, given the urgency of the need for
change, I am today announcing the key elements of our
response so that we can proceed to implementation as
quickly as possible. I have divided our response into five
areas: preventing problems from arising by putting the
needs of patients first; detecting problems early; taking
action promptly; ensuring that there is robust accountability;
and leadership. Let me take each in turn.
To prevent problems from arising in the first place, we
need to embed a culture of zero harm and compassionate
care throughout the NHS; a culture in which the needs
of patients are central, whatever the pressures of a busy,
modern health service. As Robert Francis said,
“The system as a whole failed in its most essential duty—to
protect patients from unacceptable risks of harm and from
unacceptable, and in some cases inhumane, treatment that should
never be tolerated in any hospital.”
At the heart of this problem is the fact that current
definitions of success for hospitals fail to prioritise the
needs of patients. Too often, the focus has been on
compliance with regulation rather than on what those
regulations aim to achieve. Furthermore, the way hospitals
are inspected is fundamentally flawed, with the same
generalist inspectors looking at slimming clinics, care
homes and major teaching hospitals—sometimes in the
same month. We will therefore set up a new regulatory
model under a strong, independent chief inspector of
hospitals, working for the Care Quality Commission.
Inspections will move to a new specialist model based
on rigorous and challenging peer review. Assessments
will include judgments about hospitals’overall performance,
including whether patients are listened to and treated with
dignity and respect, the safety of services, responsiveness,
clinical standards and governance.
The Nuffield Trust has reported on the feasibility of
assessments and Ofsted-style ratings, and I am very
grateful for its thorough work. I agree with its conclusion
that there is a serious gap in the provision of clear,
comprehensive and trusted information on the quality
of care. In order therefore to expose failure, recognise
excellence and incentivise improvement, the chief inspector
will produce a single aggregated rating for every NHS
trust. Because the patient experience will be central
to the inspection, it will not be possible for hospitals to
get a good inspection result without the highest standards
of patient care.
The Nuffield Trust rightly says, however, that in
organisations as large and as complex as hospitals, a
single rating on its own would be misleading. The chief
inspector will therefore also assess hospital performance
at speciality or department level. This will mean that
cancer patients will be told of the quality of cancer
services, and prospective mothers the quality of maternity
services. We will also introduce a chief inspector of
social care and look into the merits of a chief inspector
of primary care to ensure that the same rigour is
applied across the health and care system.
We must also build a culture of zero harm throughout
the NHS. This does not mean there will never be
mistakes, just as a safety-first culture in the airline
industry does not mean there are no plane crashes, but
it does mean an attitude to harm that treats it as totally
unacceptable and takes enormous trouble to learn from
mistakes. We await the report on how to achieve this in
the NHS from Professor Don Berwick. Zero harm
means listening to and acting on complaints, so I will
ask the chief inspector to assess hospital complaints
procedures, drawing on the work being done by the
right hon. Member for Cynon Valley (Ann Clwyd)and
Professor Tricia Hart to look at best practice.
Given that one of the central complaints of nurses is
that they are required to do too much paperwork and
thus spend less time with patients, I have asked the NHS
Confederation to review how we can reduce the bureaucratic
burden on front-line staff and NHS providers by a
third. I will also be requiring the new Health and Social
Care Information Centre to use its statutory powers to
eliminate duplication and reduce bureaucratic burdens.
Secondly, we must have a clearer picture of what is
happening within the NHS and social care system so
that, where problems exist, they are detected more
quickly. As Francis recognised, the disjointed system of
regulation and inspection smothered the NHS, collecting
too much information but producing too little intelligence.
We will therefore introduce a new statutory duty of
candour for providers to ensure that honesty and
transparency are the norm in every organisation, and
the new chief inspector of hospitals will be the nation’s
whistleblower-in-chief.
To ensure that there is no conflict in that role, the CQC
will no longer be responsible for putting right any problems
identified in hospitals. Its enforcement powers will be
delegated to Monitor and the NHS Trust Development
Authority, which it will be able to ask to act when necessary.
We know that publishing survival results improves
standards, as has been shown in heart surgery, so I am
very pleased that we will be doing the same for a further
10 disciplines—cardiology, vascular, upper gastrointestinal,
colorectal, orthopaedic, bariatric, urological, head and
neck, and thyroid and endocrine surgery.
The third part of our response is to ensure that any
concerns are followed by swift action. The problem with
Mid Staffs was not that the problems were unknown; it
was that nothing was done. The Francis report sets out
a timeline of around 50 warning signs between 2001