Francis Report Debate
Full Debate: Read Full DebateDepartment: Department of Health and Social Care
Grahame Morris
Main Page: Grahame Morris (Labour - Easington)Department Debates - View all Grahame Morris's debates with the Department of Health and Social Care
(10 years, 2 months ago)
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Andy Burnham
It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.
We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.
Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out.
Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS. If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.
To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.
Grahame M. Morris (Easington) (Lab)
Does my hon. Friend also recognise the growing problems in the mental health sector, as illustrated by evidence given to the Health Committee only earlier this week? We have seen the loss of 1,700 mental health beds over the last two years.
Andy Burnham
My hon. Friend anticipates me, as I will come on to that subject. My point that the NHS has gone downhill is no better illustrated than by the crisis that is developing in mental health provision.
Grahame M. Morris (Easington) (Lab)
I am honoured to be able to participate in this debate, and it is champion to follow my hon. Friend the Member for Rotherham (Sarah Champion) in the debate—
Grahame M. Morris
Thank you very much, Bob.
I want to make three points. First, I want to consider the context of the Francis report. I have the honour of serving on the Health Committee; we have held several inquiries and had the opportunity to meet and question Robert Francis on several occasions, so I am pleased to participate in this debate to consider where we are, one year on.
I also want to touch on mental health. As often happens when one speaks at the tail end of the debate, that has been raised by other hon. Members, but the issue is close to my heart. The third issue I want to discuss is the impact on social care. Although the Secretary of State kept implying that Francis is about acute hospitals, in fact his recommendations extend across the spectrum. The ideas and proposals in the 290 recommendations are just as valid for mental health and social care as they are for acute hospitals.
Clearly, the failings at Mid Staffs were absolutely shocking. I am sure that Members on both sides of the House who believe in the values of the NHS will, like me, have been appalled by those terrible events, but it is important not to conflate those terrible events with a wider diagnosis of the state of the NHS. We should think of the tremendous dedication and effort put in by the hundreds of thousands of NHS staff—I think the NHS is the biggest employer in Europe outside of the red army; it is a substantial employer—who make it such a national treasure that is ingrained in our psyche. I want to place on record the thanks of Labour Members, and, I think, the whole House, for their efforts.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Member for Beckenham has only just come in. He perhaps ought to hear a little bit more of the debate to get the flavour of it before he intervenes. That would help his good self.
Grahame M. Morris
We should remember that most hospitals provide very high standards of care, and have dedicated and compassionate staff. I am not just talking about doctors and nurses, but ancillary workers, cleaners and support staff. I worked in a pathology department as a medical scientific officer for a number of years. We should remember that the NHS is an integrated service that relies on all of its elements to perform at a high level and deliver a high-quality service.
Clearly, what happened in Mid Staffs was alarming. There were unacceptable practices, including, as other Members have said, professional failings. The hon. Member for Stafford (Jeremy Lefroy), in a terrific speech that was considered, thoughtful and non-partisan, alluded to those professional failings. My right hon. Friend the Member for Rother Valley (Kevin Barron), a former Chair of the Health Committee, made the point strongly that many Labour Members feel there should be a duty of candour on individuals. That is one of the recommendations of the Francis report that was rejected by the Government but could well make a difference. There were clear signs that changes needed to be made and we need to ensure that failures are never repeated elsewhere.
When care failures are uncovered, the priority above all else is to make a candid assessment of what went wrong and what needs to be done to fix it. Francis was clear on the need for cultural change. That is exactly what happened in the wake of the Mid Staffs scandal. Despite attempts by some Government Members to undermine Labour’s commitment to the NHS, for the record we should be aware that it was the then Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), who is now in his place, who called in Robert Francis to lead the initial review into what had happened so that we could find out what went wrong and learn lessons for the future.
I accept the point made by the hon. Member for Stafford that we should not hark back to previous Administrations, but my recollection, as a relatively new Member from 2010, is that that was not something we engaged in. It was a huge issue for Labour, and for me personally, that people were dying due not to lack of care in a hospital setting, but to the length of waiting lists—people were dying on waiting lists. After 1997, the NHS was transformed. Spending had tripled to £104 billion when Labour left office. Under Labour, 100 new hospitals were constructed, and the Labour Government employed 89,000 more nurses and 44,000 more doctors than had been employed in 1997. The transformation of the NHS under the last Government was reflected in public satisfaction with the service, which rose from record lows before 1997 to record highs.
There was a bit of contention during Prime Minister’s Question Time, and subsequently during the opening speeches in the debate. The Secretary of State suggested that the number of nurses had risen, but my information from the Royal College of Nursing and FactCheck indicates that that is not the case. I hope that the record can be corrected, because staff numbers are a key issue. A number of Members have referred to it today, and Robert Francis cited staffing as a causative factor.
It would, I think, be irresponsible to assume that a combination of implementing the Francis recommendations—even all of them—and talking down the last Government will be sufficient to ensure the provision of high-quality care throughout the NHS. The truth is that the combination of cuts in alternative services—I am not just talking about the replacement of NHS Direct with the 111 service, the reduction in the number of walk-in treatment centres, the difficulties in gaining access to GP services and, indeed, the cost and disruption caused by the top-down reorganisation—is more likely to contribute to failures in care. It will certainly increase the pressure on accident and emergency departments.
The Francis report made it clear that the “overwhelmingly prevalent factors” in the failures at Mid Staffordshire
“were a lack of staff, both in terms of absolute numbers and appropriate skills”.
It was made clear that ensuring that our hospitals are adequately staffed is key to ensuring that standards of care are high. That point was made by the hon. Member for St Ives (Andrew George), who I know has been campaigning on the issue for some time. A year on from the Francis report, a survey found that 39% of nurses believed that the staffing position had become worse rather than better, and 57% said that their wards remained dangerously understaffed. I hope that the Minister has noted that, because it must be cause for concern.
The hon. Member for Stafford told us that when he was first elected the NHS trust was running a deficit of £10 million, and the focus of the hospital management was on reducing the deficit in order to secure foundation trust status. What went through my mind then were figures given to the Select Committee, according to which nearly a third of NHS trusts are predicting deficits towards the end of the current financial year, and the possibility that similar pressures will be applied as a result. We are now seeing the spectre of clause 119 of the Care Bill, which we are to debate next week on Report and Third Reading. If it paves the way for rapid hospital closures—Labour Members fear that predatory private health care interests may seize the opportunity—that will be very dangerous. We must examine that issue very seriously.
According to evidence from the survey conducted, I think, by the RCN, not only are hospital wards increasingly understaffed, but nurses are being burdened with work that is preventing them from doing their jobs. I am sorry to fire statistics at the House, but, according to that evidence, 86% agreed that the amount of non-essential paperwork had increased in the last two years. There has thus been an historic recent increase in administrative duties. That has been keeping nurses in their offices or at their nurse stations, standing in front of computers or photocopying machines, instead of being available on the wards providing the TLC—that direct health care—that patients require.
Just this week the president of the Royal College of Psychiatrists warned the Government that the mental health sector is heading towards its own Mid Staffs-type scandal. I am very concerned about that. The figures for that field were given earlier, but the fact that the budget for mental health services is reducing in real terms should be a cause for concern. This Government gave a commitment to parity of esteem as between physical and mental health. That was promised and loudly trumpeted as a significant step forward, but in truth it has failed to materialise. There is a clear funding imbalance between acute providers and non-acute trusts, which will disproportionately impact on mental health services in the wake of the Francis report.
I also want to touch on the tariff reduction. In 2014-15 there will be an overall reduction in the tariff price—essentially, the price that hospitals are paid for procedures and operations they perform—of 1.5% for acute providers and 1.8% for non-acute trusts. A third of NHS trusts are predicting they will be in deficit at the end of the financial year, and this tariff reduction will only compound that problem. This means the efficiency target for mental health and community trusts is in practice a fifth higher than for acute trusts, so perhaps it is no wonder that we have a chronic bed shortage, highlighted by various newspapers and the BBC, with children and adolescents travelling long distances to access appropriate care and sometimes temporarily being put in police cells. This is not acceptable, and there are real concerns that programmes introduced by the last Labour Government to make talking therapies available to people with mental health conditions are not getting the priority they deserve. Last year half of all patients referred for counselling did not see a specialist, with a third giving up entirely because the waits were so long.
As I mentioned in an earlier intervention, 1,700 mental health beds have been lost over the last two years, and services are under such pressure that people with mental illnesses are ending up either in police cells or presenting at accident and emergency departments, as the right hon. Member for Sutton and Cheam (Paul Burstow) said. Those are completely inappropriate locations.
I want to mention the cuts to social care since 2009 and the impact they are having on the ability of the service to deliver quality care in the light of our review of the Francis recommendations. We should not forget that since 2009-10 some £1.8 billion has been cut from local authority budgets for adult social care. The cumulative spending power of my own local authority, Durham county council, is being reduced by 17.3% under this Government.
Areas such as mine with a legacy of coal mining or industry have higher care needs. These are the areas that are being hardest hit by cuts to local government. It is simply not possible to make cuts of this significance to local government without it having an impact on standards of care. Some 76% of community nurses agree that social care cuts have resulted in increased work pressures, with just 15% thinking that patients are receiving adequate support from social care services. Cuts mean that an increasing number of those with care needs are going without any support—the figure I have seen is about 800,000—and those receiving support are not even having basic needs met. We know about the 15-minute visits, and councils are now having to introduce or increase charges for services that may well have been free before or might be free in other parts of the country.
Care in the home and in the community is declining, and people are turning to their local hospitals—this is the point I am trying to make—as the default option. That means that those who should be taken care of at home are staying unnecessarily in hospital beds. Accident and emergency is the coal face—the pressure point—and any failures in the system show up there, putting even more pressure on an already burdened system. In “The Francis Report: one year on”, Robert Francis said that there needs to be
“a frank discussion about what needs to be provided within the available resources…It is unacceptable to pretend that all can be provided to an acceptable standard when that is not true.”
I agree with him. It is no good telling people that care standards will be improved or maintained while removing the support that is required to provide high standards of care, particularly social care. In conclusion, I agree with the Health Committee that legislation and regulatory bodies can only do so much to ensure that care standards are met if the necessary staff and resources are not available.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I now have to announce the result of Divisions deferred from a previous day.
On the motion relating to the draft Marriage (Same Sex Couples) (Jurisdiction and Recognition of Judgments) Regulations 2014, the Ayes were 360 and the Noes were 104, so the Question was agreed to.
On the motion relating to the draft Marriage of Same Sex Couples (Registration of Shared Buildings) Regulations 2014, the Ayes were 363 and the Noes were 100, so the Question was agreed to.
On the motion relating to the draft Marriage of Same Sex Couples (Use of Armed Forces’ Chapels) Regulations 2014, the Ayes were 366 and the Noes were 103, so the Question was agreed to.
On the motion relating to the draft Consular Marriages and Marriages under Foreign Law Order 2014, the Ayes were 367 and the Noes were 100, so the Question was agreed to.
On the motion relating to the draft Marriage (Same Sex Couples) Act 2013 (Consequential and Contrary Provisions and Scotland) Order 2014, the Ayes were 365 and the Noes were 103, so the Question was agreed to.
On the motion relating to the draft Overseas Marriage (Armed Forces) Order 2014, the Ayes were 368 and the Noes were 98, so the Question was agreed to.
I now call Alex Cunningham.
Liz Kendall
Wherever there is evidence of poor care, it must be looked into. The hon. Gentleman did not mention that the Welsh Assembly has ordered a specific independent inquiry by experts outside Wales into aspects of care at the Princess of Wales and Neath Port Talbot hospitals, which I welcome.
Of all the lessons to be learned from Mid Staffordshire, the most important one is that the primary cause of the failures was the hospital and the trust board not listening to patients and their families, and not putting their needs and concerns first. Sir Robert Francis rightly says that there must be fundamental changes to ensure the real involvement of patients and the public in all that is done and to secure a common patient-centred culture throughout the NHS.
National Voices, a coalition of more than 130 patient, user and carer organisations, says that a concerted drive to listen to patients and carers must be a top priority for all trust boards and care organisations. It emphasises that over and above regulation, which it says has
“an important but limited role in ensuring quality and safety.”
Ministers have rightly spoken about the need for effective regulation and have taken some welcome steps, but the Care Quality Commission and the new chief inspectors will not be the main way of preventing the sort of failings we saw at Mid Staffordshire. Regulation identifies problems when they have begun, rather than preventing them from happening in the first place. Regulators cannot be everywhere all the time, but patients and their families are, which is why their views must be heard from the bedside to the boardroom, and at the heart of Whitehall.
The Labour Government made important progress. They published, for the first time, data on stroke and cardiac care. That helped to improve standards for patients and was a powerful incentive for staff to make changes. The next step is to provide systematic and comprehensive patient feedback. That must move from being the exception to being the norm.
The Government’s friend and families test is welcome as far as it goes but, as National Voices says,
“it is a crude measure on which the NHS would be unwise to place too much reliance.”
It asks only whether patients would recommend an NHS service to others, but not why, and it does not provide the detailed, real-time feedback that patients want and staff need to improve the quality of care. Developments such as the patient opinion and care opinion websites offer a powerful way forward. They enable people to tell the story of their NHS or care experience online, in writing or on the phone. That gives patients a voice, allows other people to see what is being said about a service, and in a simple and cost-effective way provides staff with a direct incentive to improve.
The Secretary of State said we must all be champions for change, and hon. Members may remember that I wrote to everyone saying that as a Member of Parliament they should sign up because it is a great way for us to understand what is really going on. I have asked my hospital trust and other services to do the same. That will be a powerful way of making change happen.
We must also look at how staff are trained to ensure that they always put patients first. Places such as Worcester university are leading the way: patients and families help to interview people who are applying to be nurses and health care assistants; they help to develop the content of courses so that they include what really matters to patients; and they take part in teaching students. Ministers should have spent the last three years championing such initiatives instead of reorganising the training structures as a result of the Health and Social Care Act 2012.
Individual patient voices are not the only ones that must be heard. We need a strong collective voice for users. The Francis report recommended investing in patient leaders to speak out on behalf of the public, to help to design services locally, and to hold them properly to account. Ministers claimed that that is what Healthwatch would do, but their rhetoric is simply not matched by the reality: national Healthwatch has nowhere near the same power, authority or levers to change services as NHS England, the Care Quality Commission or Monitor.
Local Healthwatch bodies are also weak. They were late out of the starting blocks and are woefully understaffed. Last week, we heard that £10 million of the £40 million budget that was promised for local Healthwatch has gone missing, despite the explicit recommendation in the Francis report that
“Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch”.
If Ministers are serious about giving patients a strong voice locally, they must look again at the support that Healthwatch is getting on the ground.
A strong patient voice is more essential than ever before because of the huge pressures on local services. Across the country, the NHS is struggling to cope with the increasing number of frail elderly people ending up in hospitals that were designed for a different age. Twenty per cent. of hospital beds have older people in them who need not be there if they had the right support in the community or at home. Half a million fewer people are receiving basic help to get up, washed, dressed and fed as council care budgets are cut to the bone. Mental health services, especially for children, are under intolerable strain as money for vital community services is being diverted to cope with pressures elsewhere in the system. This is not good for patients and families, it puts staff under pressure, and it ends up costing the taxpayer far more as people end up in more expensive hospital care or, in the case of mental health patients, being transported hundreds of miles around the country.
The NHS needs radical change, not to its back-room structures but to its front-line services and support. Improving safety and quality means that some services must be concentrated in specialist centres and others must be shifted out of hospitals into the community and towards prevention, fully integrated with social care. Under the previous Government, plans had been drawn up to reorganise services in every English region through Lord Darzi’s next stage review, but rather than pushing forward with those plans and making the changes that patients want and need, Ministers scrapped them simply because they were developed under the previous Labour Government. Instead, they embarked on a huge back-room NHS reorganisation, wasting precious time, effort and resources.
As several hon. Members have said, the new NHS structures are utterly confusing, with no clear lines of accountability or responsibility. There are now 211 clinical commissioning groups, 152 health and wellbeing boards, 27 NHS England local area teams, four NHS England regional teams—I am not sure what they are doing—23 commissioning support units, and 10 specialist commissioning units, alongside Monitor, the Care Quality Commission and NHS England. Can you make sense of that, Mr Deputy Speaker? Who is providing the leadership? Who is to be held to account? Across the country, people are doing their contract negotiations for next year, trying to make changes to services, and they say to me that there is no clear leadership in the system. That must change.
We have heard a lot about changing the culture in the NHS. That culture is about behaviour and the millions of personal interactions that happen every single day in the NHS. Getting those right will not happen through regulation alone but by giving patients and the public a powerful voice in every part of the system. This issue has had too little attention since the Francis report was published. Crucially, the culture is about leadership, and leadership comes from the top.
I warn Ministers not to be complacent about saying that the bullying culture has gone. On Friday, I met the chief executive of a trust who showed me an e-mail from the NHS Trust Development Authority, which is quite close to Ministers’ doors. I will not be able to say exactly what it said because it contained swear words, but it said, in effect: “Open the beep beds; just beep do it.” That was in an e-mail to a chief executive. The bullying culture is still going on. Ministers need to get a grip, particularly on what is happening at the NHS Trust Development Authority, which is causing real problems in the system.
Grahame M. Morris
This is more pervasive than something that happens at the highest level. When members of my trade union, Unite, from the Yorkshire ambulance service raised legitimate concerns about the impact on the service of privatisation and de-skilling, the reaction of management was to de-recognise the trade union. That is outrageous.
Liz Kendall
This is not leadership; this is not what we want in our health service.
Real leadership is about setting a vision and working with staff and patients to make it happen. Yesterday Sir John Oldham published the report of his independent commission on whole-person care, which was drawn up with people who have worked in the system and sets out the reforms that we need to ensure that our NHS and care services are fit for the future. Across the NHS, patients and staff are crying out for clear leadership. Until we get this right, we will not really have learned the lessons from the failings of Mid-Staffs.