With permission, Mr Speaker, I would like to make a statement about the Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry.
Let me start by paying tribute to the men and women of courage, without whom this darkest episode in the history of the NHS would never have come to light. I am talking about people such as Julie Bailey and members of Cure the NHS, who stood outside the Department of Health in all weathers because no one would meet them to hear about the inhumane care given to their loved ones; brave whistleblowers such as Mid Staffs nurse Helene Donnelly; and campaigners who suffered tragedies elsewhere such as James Titcombe, who never gave up the fight after losing his son Joshua at Morecambe Bay. They suffered greatly for their selfless determination to ensure that their personal losses were not in vain. All of us in the House are humbled today to stand in the giant shadow of their bravery.
Robert Francis and his team also deserve huge credit. Their diligence and thoughtfulness led to an outstanding reform, which will transform our NHS for the better. Finally, let me pay tribute to all NHS front-line staff for whom reading about these events in the media has been immensely distressing. We owe it to them to make sure that poor care is never again allowed to take root and survive unchallenged in our NHS.
Since our initial response to the inquiry in March, much has happened. Thirteen hospitals have been put into special measures as part of a tough new failure regime. Those hospitals, where poor care had been allowed to persist, are now being turned around, and I thank the Keogh inquiry team for its painstaking work in that area. Independent Ofsted-style ratings of hospitals are under way, led by Professor Sir Mike Richards, the new chief inspector of hospitals. The first 18 trusts are currently being inspected, with quality of care and safety paramount. We have appointed new chief inspectors of adult social care and general practice, whose robust inspections of care homes, domiciliary care and surgeries start next year, and surgical survival rates for 10 major specialties have been published by individual surgeons, making the NHS a world-leader in transparency.
Today the Government are publishing our further response to the inquiry, as well as our response to the Select Committee on Health’s report on the inquiry. Both responses have been laid before Parliament.
The NHS is a moral being or it is nothing. It was set up 65 years ago with the noble ideal that no one should ever be prevented by background or finance from accessing the best care. That is why it remains the most loved British institution, and rightly so. But each and every case of poor care betrays those worthy aims. I do not simply want to prevent another Mid Staffs. I want our NHS to be a beacon across the world for not just its equity but its excellence. I want it to offer the safest, most compassionate and most effective care available anywhere. I believe that it can, but only if there is a profound transformation of the culture in the NHS.
The inquiry shows the devastating effects of overly defensive responses: hurting families, suppressing the truth and preventing lessons from being learned. Failure
cannot be addressed when it is covered up, so today I am announcing new measures to promote a culture of openness and transparency. From 2014, every organisation registered with the Care Quality Commission will have a statutory duty of candour. Patients must be told promptly about any avoidable harm, but there will be a statutory requirement to notify any harm that has led to avoidable death or serious injury.
We will consult on whether hospitals that are found not to have been open and transparent with patients or families at the earliest reasonable opportunity should risk having their indemnity from litigation awards reduced or removed by the NHS Litigation Authority. The signal must go out loud and clear from hospital boards and chief executives to all clinicians: if in doubt, report an incident and tell the patient. The professional regulators have agreed to place a new, strengthened professional duty of candour on all doctors and nurses. Failing to inform a patient, not reporting avoidable harm or obstructing someone else seeking to do so will be subject to sanctions, including being struck off.
Inspired by the airline industry, the duty will cover “near misses”—occasions when mistakes were made that could have led to harm and from which we need to learn. Conversely, prompt reporting may be considered as a mitigating factor in a professional conduct hearing. That is not about penalising staff for making mistakes; it is about enabling them to learn from them. The NHS will adopt a culture of learning, as recommended by Don Berwick and his expert committee, and I thank them for their seminal report.
A culture of openness also means learning from complaints. In line with the recommendations of the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart’s excellent review, all patients will be able to access independent help in making their complaint, with clear signs in every ward explaining how to do so. The chief inspector of hospitals will inspect complaints handling to establish whether trusts are genuinely seeking to understand and learn from them; every quarter, trusts will publish the number of complaints received and lessons learned; and the health service ombudsman will dramatically increase the number of cases she looks at in detail.
It is impossible to deliver safe care without safe staffing levels. All hospitals will be required to monitor their staffing levels on a ward-by-ward basis, analysing precisely how many shifts meet safe staffing guidelines. By the end of this year, this will be done using models independently approved by the National Institute for Health and Care Excellence. No hospital will be able to conceal unsafe staffing from the public because from next June all that data, both at ward and hospital level, will be published alongside other safety data on a new NHS safety website, triggering CQC action if there is cause for concern.
Things are already changing for the better and I am pleased to report that trusts are planning to recruit an additional 3,700 nurses compared with a year ago, but we need to go further to train and motivate staff, particularly the health care assistants and social care support workers who perform so much vital care. Health care assistants and social care support workers will be required to have a new care certificate to ensure that no one is ever asked to perform personal care without adequate training, whether in hospitals or care homes.
The title “nursing assistants” will be used widely in hospitals, and paths to nursing careers will be improved. I thank Camilla Cavendish for her excellent work in this area.
We also need to broaden the talent pool going into NHS management positions, in particular by attracting more clinicians and those with good external experience. We have introduced a fast-track leadership programme, sending 50 people a year to a world-leading business school followed by time shadowing top NHS chief executives.
Robert Francis correctly highlighted the failure of regulatory systems to identify quickly what happened at Mid Staffs. Subsequently it has become clear that Ministers put pressure on regulators that may have led them to tone down news about poor care. That is totally unacceptable, so we will strengthen the statutory independence surrounding reports into care quality. The chief inspector will be the nation’s whistleblower-in-chief and nothing must ever be allowed to stand in his way.
The CQC can prosecute when fundamental standards are breached and trusts put into special measures will have a strictly limited time to get their house in order before administration is considered. Foundation trusts in special measures will have their autonomy suspended and action will be taken to ensure that they quickly improve. No trust will be able to progress to foundation status unless it is rated good or outstanding.
Proper accountability must be at the heart of the NHS. I have therefore accepted Professor Berwick’s recommendation of legal sanctions for those found guilty of wilful neglect or ill treatment. There will be a new criminal offence for care providers that supply or publish false or misleading information and a new fit and proper persons test will enable the CQC to bar unfit directors from boards.
Finally, every hospital patient should have the names of a responsible consultant and nurse above their bed. Starting with over-75s from next April, there will be a named accountable clinician for out-of-hospital care for vulnerable older people.
One of the most chilling accounts in the Francis report came from Mid Staffs employees who considered the care they saw to be “normal”. Cruelty became normal in our NHS and no one noticed. The Francis report made 290 recommendations. I accept the principles behind all of them, and wherever possible have adopted the practical solutions suggested by the inquiry. Robert Francis has welcomed today’s announcement as a carefully considered and thorough response to his recommendations, which he says will contribute greatly towards a new culture of caring and making our hospitals safer places for their patients.
Today’s measures are a blueprint for restoring trust in the NHS, reinforcing professional pride in NHS front-line staff and above all giving confidence to patients that after Mid Staffs the NHS has listened, the NHS has learned and the NHS will not rest until it is delivering the safest, most effective and most compassionate care anywhere in the world. I commend this statement to the House.
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