My Lords, with the leave of the House, I will now repeat a Statement made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows.
“With permission, Mr Speaker, I would like to make a Statement on measures to improve the safety culture in the NHS and further strengthen its transition to a modern, patient-centric healthcare system. The failings at Mid Staffs detailed in the Francis report were not ‘isolated local failures’. Facing up to widespread problems with the safety and quality of NHS care and learning the appropriate lessons has been a mission which the Government and the NHS have shared, with a common belief that the best way to deal with problems is to face up to them, rather than wish they did not exist.
Measures taken in the last Parliament include introducing the toughest independent inspection regime in the world, more transparency on performance and outcomes than any other major healthcare system, new fundamental standards, a duty of candour and the excellent recommendations made by Sir Robert Francis QC. But because the change we need is essentially cultural, a long journey still remains ahead. The Department of Health was described during the Mid Staffs era as a ‘denial machine’. We therefore have much work to do if we are to complete the transformation of the NHS from a closed system to an open one, from one where staff are bullied to one where they are supported, and from one where patients are not ignored but listened to.
So today I am announcing some important new steps, including our official response to Sir Robert Francis’ second report, Freedom to Speak Up; our response to the Public Administration Committee report, Investigating Clinical Incidents in the NHS; and our response to the Morecambe Bay Investigation. I am also publishing the report of the noble Lord, Lord Rose, into leadership in the NHS—a key part of the way we will prevent these tragedies happening again. I would like to thank everyone involved in writing those reports for their excellent work.
In his report, Freedom to Speak Up, Sir Robert Francis QC made a number of recommendations to support this cultural change. All NHS trusts will appoint someone whose job is to be there when front-line doctors and nurses need someone to turn to with
concerns about patient care that they feel unable to raise with their immediate line manager. We will also appoint an independent national officer, located at the Care Quality Commission, to make sure all trusts have proper processes in place to listen to the concerns of staff, before they feel the need to become whistleblowers. Other changes will include information about raising concerns as part of the training for healthcare professionals and curriculum for medical students, as well as a greater focus on learning from reflective practice in staff development.
Dr Bill Kirkup’s report into Morecambe Bay brought home to this House that there can be no greater pain than for a parent to lose a child and then find that pain compounded when medical mistakes are covered up. We will accept all of the recommendations in this report, including removing the Nursing and Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom and bringing the regulation of midwives into line with the arrangements for other regulated professions.
Likewise, we agree with the vast majority of the recommendations of the excellent report of the Select Committee on Public Administration into clinical incident investigations. In particular, we will set up a new independent patient safety investigation service by April 2016, based on the success of the ‘no blame’ approach used by the Air Accidents Investigation Branch in the airline industry. It will be housed at Monitor and the TDA, which have the important responsibility of promulgating a learning culture throughout the NHS. Monitor and the TDA will operate under the name ‘NHS Improvement’ and Ed Smith, currently a non-executive board member of NHS England, will become the new chair, with a brief to appoint a new chief executive by the end of September.
For NHS managers, the report of the noble Lord, Lord Rose, Better Leadership for Tomorrow, makes vital recommendations to join up the support offered to NHS managers, to improve training and performance management and to reduce bureaucracy. He extended his remit to cover the work of clinical commissioning groups, which play a key role in the NHS, and today I am accepting all 19 of his recommendations in principle, including moving responsibility for the NHS Leadership Academy from NHS England to Health Education England.
These are important recommendations, which, in the end, all share one common thread: the most powerful people in our NHS should not be politicians, managers, or even doctors and nurses—they should be the patients who use it. Using the power of intelligent transparency and new technology, we now have the opportunity to put behind us a service where you ‘get what you are given’, and to move to a modern NHS where what is right for the service is always what is right for the patient.
A litmus test of this is our approach to weekend services. Around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals. You are 15% more likely to die if you are admitted on a Sunday, compared with being admitted on a Wednesday. This is unacceptable to doctors as well as patients. In 2003-4, the then Government gave GPs and consultants the right to opt out of out-of-hours and weekend work, at the same time as offering significant
pay increases. The result was a ‘Monday-to-Friday’ culture in many parts of the NHS, with catastrophic consequences for patient safety. In our manifesto this year, the Conservative Party pledged to put this right, as a clinical and a moral priority.
So, I am today publishing the observations on seven-day contract reform for directly employed NHS staff in England by the Review Body on Doctors’ and Dentists’ Remuneration and the NHS Pay Review Body. They observe that some trusts are already delivering services across seven days, but this is far from universal. According to the DDRB, a major barrier to wider implementation is the contractual right of consultants to opt out of non-emergency work in the evenings and at weekends, which reduces weekend cover by senior clinical decision-makers and puts the sickest patients at unacceptable risk. The DDRB recommends the early removal of the consultant weekend opt-out, so today I am announcing that we intend to negotiate the removal of the consultant opt-out and the early implementation of revised terms for new consultants from April 2016. There will now be six weeks to work with the BMA union negotiators, before a September decision point. We hope we can find a negotiated solution, but are prepared to impose a new contract if necessary. To further ensure a patient-focused pay system, we will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards, to reward those doctors making the greatest contribution to patient care.
I am also announcing other measures today to make the NHS more responsive to patients. These include making sure patients are told about CQC quality ratings, as well as waiting times, before they are referred to hospitals, so that they are able to make an informed decision about the best place to receive their care. NHS England will also develop plans to expand control to patients over decisions made in maternity, end-of-life care and long-term condition management, which I will report in more detail subsequently to the House. Finally, because the role of technology is so important in strengthening patient power, we must ensure no patient is left behind in the digital health revolution. I have therefore asked the noble Baroness, Lady Lane-Fox, formerly the Government’s Digital Champion, to develop practical proposals for the NHS National Information Board on how we can ensure increased take-up of new digital innovations in health by those who will benefit from them the most.
When we first introduced transparency into the system to strengthen the voice of patients, some called it ‘running down the NHS’. In fact, since then public confidence in the NHS in England has risen 5 percentage points. By contrast, Wales, which resisted this transparency, saw public satisfaction fall by 3 percentage points. Over the last Parliament, the proportion of people who think the NHS in England is among the best healthcare systems in the world increased by 7 percentage points; those who think NHS care is safe increased by 7 percentage points; and those who think they are treated with dignity and respect increased by 13 percentage points. This demonstrates beyond doubt the benefits of an open, confident NHS, truly focused on learning and continuous improvement.
But as we make progress in this journey, we must never forget the families who have suffered when things have gone wrong—in particular, the families and patients at Morecambe Bay and Mid Staffs, the whistleblowers who contributed to Sir Robert Francis’s work and everyone who has had the courage to come forward in recent years to help reshape the culture of the NHS. Without their bravery and determination, we would not have faced up to the failures of the past, nor been able to construct a shared vision for the future. We are all massively in their debt; this Statement remains their legacy and I commend it to the House”.
My Lords, that concludes the Statement.
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