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
and 2009, yet Ministers and managers in the wider system failed to act on those warnings. Some were not aware of them; others dodged responsibility. That must change. No hospital will be rated as good or outstanding if fundamental standards are breached, and trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do that, they will be put into a failure regime that could ultimately lead to special administration and the automatic suspension of the board.
The fourth part of our response concerns accountability for wrongdoers. It is important to say that what went wrong at Mid Staffs was not typical of our NHS, and that the vast majority of doctors and nurses give excellent care day in, day out. We must ensure that the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS.
Francis said that primary responsibility for what went wrong at Mid Staffs lies with the board. We will, therefore, look at new legal sanctions at corporate level for organisations that wilfully generate misleading information or withhold information that they are required to provide. We will also consult on a barring scheme to prevent managers found guilty of gross misconduct from finding a job in another part of the system. In addition, we intend to change the practices around severance payments, which have caused great public disquiet.
The General Medical Council, the Nursing and Midwifery Council, and other professional regulators have been asked to tighten their procedures for breaches of professional standards. I will wait to hear how they intend to do that, and for Don Berwick’s conclusions on zero harm, before deciding whether it is necessary to take further action. The chief inspector will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable health care support workers are barred.
The final part of our response will be to ensure that NHS staff are properly led and motivated. As Francis said,
“all who work in the system, regardless of their qualifications or role, must recognise that they are part of a very large team who all have but one objective, the proper care and treatment of their patients”.
Today I am announcing some important changes in training for nurses. I want NHS-funded student nurses to spend up to a year working on the front line as support workers or health care assistants as a prerequisite for receiving funding for their degree. That will ensure that people who become nurses have the right values and understand their role. Health care support workers and adult social care workers will now have a code of conduct and minimum training standards, both of which are being published today. I will also ask the chief inspector to ensure that hospitals are properly recruiting, training and supporting health care assistants, drawing on the recommendations being produced by Camilla Cavendish. The Department of Health will learn from the criticisms of its own role by becoming the first Department in which every civil servant will have real and extensive experience of the front line.
The events at Stafford Hospital were a betrayal of the worst kind—a betrayal of patients, families, and the vast majority of NHS staff who do everything in their power to give their patients the high-quality, compassionate
care they deserve. I want Mid Staffs to be not a byword for failure but a catalyst for change, and to create an NHS where everyone can be confident of safe, high-quality, compassionate care, and where best practice becomes common practice, and the way a person is made to feel as a human being is every bit as important as the treatment they receive. That must be our mission and I commend this statement to the House.
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