Mid Staffordshire NHS Foundation Trust

Jeremy Lefroy Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

Let me take the right hon. Gentleman’s points in turn. First, he will know, because this is what happened after the Bristol inquiry and the Shipman inquiry under the previous Government, that Governments do not always accept every single recommendation. What I have said today is that we accept all the principles behind every single one of Robert Francis’s recommendations. We are implementing 204 in full, and in respect of the 86 that we are not implementing exactly as he said, we are doing everything we can to make sure that we implement the spirit behind them, but we need to make sure that everything we do is workable in practice. Francis himself has said that it is a “carefully considered” response that is a “comprehensive collection of measures”.

On staffing numbers, which is an essential part of what we have to consider, if the right hon. Gentleman looks at the nursing hours per bed, he will find that they have gone up since 2010, not down. We recognise the crucial importance of front-line staff, which is why I gently say to him that we made some reforms to the NHS that meant that there are 5,500 more doctors on the front line and 8,000 fewer managers. What we also need is more nurses. That is why it is so encouraging that in response to what Robert Francis has said and the recognition throughout the NHS of the importance of compassionate care, we are getting a reaction from NHS trusts—not as a result of a direct ministerial decision, but because trusts themselves are recognising the importance of compassionate care. We think that is a very encouraging sign.

With respect to whether staffing levels should be mandatory, we agree that there are minimum recommended staffing levels, but they are not the same for every ward in every hospital. The minimum level might be one in six for an acute medical unit, one in four for a general medical unit, and one on one for intensive care. We took extensive advice on whether it would be appropriate to set a national minimum mandatory number. Not only is the chief nurse and leading nurses from across the country against this; the King’s Fund and the British Medical Association are against it. The BMA said something today in a statement which I never thought I would read in my lifetime—it said that the “Government is right” on this issue.

The right hon. Gentleman also opposed mandatory staffing levels back in 2011, although it is fair to say that in the House his position on this has changed. The important thing is that we allow local discretion to make sure that nursing levels are adequate, and that where they are not, that is exposed quickly so that there is no repetition of what happened at Mid Staffs.

On the regulation of health care assistants, every health care assistant will have to have a care certificate. Effectively, there will be a database which allows employers to check whether someone has such a certificate. That is a kind of register. The other reason for people talking about the regulation of health care assistants is that they want to make sure that if someone fails in their duty of care, they are not able to appear somewhere else in the country. That is why we have a vetting and barring scheme to make sure that that does not happen.

On the individual duty of candour, let us be clear: we want total candour about all avoidable harm, at every stage that it happens, anywhere in the NHS. We decided after much discussion that extending the statutory duty of candour to individual front-line clinicians would be likely to create a huge amount of bureaucracy and damage the culture of openness that we are trying to create, because everyone would constantly be worried about whether or not they were breaking the law. We decided that the right way to achieve the objective is through a professional duty of candour, which is much stronger than the current professional duty states. Critically—this is a key change—we decided to make sure that, just as airline pilots have protection if they speak out, if front-line NHS employees speak out, they too will get protection if there is a professional conduct case, and that openness at an early stage will be treated as a mitigating factor. That is really important in terms of changing the culture.

Finally, we absolutely do need to resolve the issue of death certificates. It is important that we have an independent view to certify deaths. It is a question of finding a practical way to make sure that we do that, but we very much accept the spirit of what Robert Francis said.

Today I hope that we will find a way forward on all the problems that Robert Francis addressed in his response and that we have been thinking hard about. I urge the shadow Secretary of State to join Government Members in saying that this is a moment when the NHS can once again reach forward and aim to be the very best in the world, because the kind of measures that we are talking about are not happening anywhere else, and that is something of which we can all be very proud.

[Jeremy Lefroy (Stafford) (Con)]

I thank my right hon. Friend the Secretary of State for his statement and commitment. A culture of compassionate and safe care for all in the NHS must be the legacy of the Francis inquiry. It is the least that those who suffered from dreadful neglect, and their loved ones who campaigned for justice, deserve. Staff throughout Mid Staffordshire trust have made firm strides since then in improving that culture with clear results in patient care, but will my right hon. Friend be the patients champion and ensure that the NHS puts patients first and foremost?

[Mr Hunt]

That is the central change in culture that we need throughout the NHS. I pay tribute to my hon. Friend in particular, because he has had a more difficult challenge with respect to his local hospital than any hon. Member. He has campaigned for the people who use that hospital and for the staff there with great integrity and courage, which I commend.

I have never believed that there is a conflict or a choice between putting NHS staff first and putting the patient first. I have never met a doctor or nurse who does not want to put the patient first. The trouble is that we have created structures and incentives that make it difficult for front-line staff to do what they joined the NHS to do, which is to care for patients with dignity, compassion and respect. That is what we are trying to do in the changes today.