Accountability and Transparency in the NHS

Nick de Bois Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Aidan Burley (Cannock Chase) (Con)]

rose—

[Nick de Bois (Enfield North) (Con)]

rose—

[Andy Burnham]

I will give way one final time—to the hon. Member for Cannock Chase (Mr Burley).

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[Rosie Cooper (West Lancashire) (Lab)]

I welcome the opportunity to speak in this debate on our national health service. I resolutely believe that we should have an open and honest debate on how we can each contribute to restoring faith in the national health service, and that we should not play politics with the findings of the Francis report.

Increasingly, there is a deeply concerning creeping veil of secrecy across the public sector—local government, education or health. The application of greater accountability and transparency is the solution, ensuring that the interests of the public remain the singular and overriding No. 1 priority in public service delivery. As a society, we display a huge and deep faith that the NHS is intrinsically good, and we want unquestioningly to believe that at all times it is acting in our best interests. The findings of the Francis report, as they should, shake that faith and belief in the NHS to its very core. Francis should be commended for his report—an extensive and comprehensive forensic examination of Mid Staffs and the structure of the NHS.

I will be as brief as I can and focus on one tiny element: listening to patients, the people who pay for the NHS, and hearing what they are saying and acting on it. We do not need to keep on looking for a black cat in a dark room. Switch the light on! It is no good the Secretary of State simply repeating that we must listen to patients and their families. What assurance does he have that, until the next crisis, they are listening? In hearing after hearing of the Health Committee, senior people associated with the NHS trot out that the regulator is responsible and that the Care Quality Commission needs to deal with it. I never, ever thought I would feel sorry for the CQC, but, when everyone else ducks, it is supposed to catch the ball. We do not need to create another bureaucracy; we simply have to make work—really work—something we already have by giving it real teeth and enough resources to make it effective.

I agree with the comments of Dame Julie Mellor, the parliamentary and health service ombudsman, when she said that she hoped that the Francis report

“will trigger a debate that will support our view that good complaint handling should be at the heart of the NHS.”

From front-line experience, I believe that to be both true and essential. During my time as chair of Liverpool Women’s hospital, a standing agenda item at the public monthly board meetings was a summary of all complaints received that provided an overview—not in minute detail, but an overview—of each complaint and the outcome: upheld or not upheld. Most importantly, there was a column that stated what action was taken. Employing this system of regular review ensured that the board had oversight, asked questions, could spot trends, be assured that action was taken and demonstrate to patients and their families that they were being listened to.

[Nick de Bois]

Does the hon. Lady accept, notwithstanding the efforts made in the hospital she mentions, that when MPs take up complaints on behalf of constituents and try to get to the truth behind them, we are faced with tremendous bureaucracy and resistance?

[Rosie Cooper]

Yes, and if MPs have problems, God help members of the public and patients.

We had to demonstrate that we were really listening to patients. The medical and managerial staff had to take ownership and responsibility for complaints. They knew that at each board meeting they could be questioned and challenged. If we accept that there are large parts of the system that work well and focus our time and resources on areas that do not, we can raise standards and tackle deep-seated problems. As chair, I sought to build in assurance and be transparent about complaints; to solve them, not hide from them, and ensure that everyone was accountable right up through the management structure. I never believed in no blame; I believed in fair blame. Each time a problem was resolved properly, we became a better hospital. We were rightly proud that on the front page of the Liverpool Echo Liverpool Women’s hospital was called an NHS gem. Sadly, the main board’s complaints report stopped after I stepped down as chair.

We do not need to reinvent the wheel or have more reorganisation in the NHS, but we must make the complaints system work. From that important but simple action, culture changes happen and become embedded in the organisation. We then have real change, real transparency, real openness and real accountability—something we can all be proud of.

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[Nick de Bois (Enfield North) (Con)]

I will never forget the last time I saw my mother. It was three days before the general election in 2005. She had secondary cancer, but she was a fighter, though I make no comparison between her circumstances and the Francis report and the horrors that people went through at Stafford.

There are many reasons why someone might remember the last time they saw their mother, but my experience is overshadowed by a sense of guilt. During my mother’s long stay in hospital—she had been in and out—my brother, who lived abroad, had often been with me and he persistently picked up that the pervading culture on the ward was that he who shouted loudest got attention. My mother would describe how much pain and discomfort she was in—other Members have mentioned similar problems—and say, as elderly people do, “Don’t make a fuss.” To his credit, my brother dealt with it by shouting loud. On that last day, my brother was not with me because he had returned abroad. Unfortunately, I did not shout that day. I went back to the election and my mother sadly died. I am not drawing a comparison with what happened in Stafford, but many patients and relatives will recognise that one has to shout loudly to get heard. That points to a problem with the culture.

In 2005, to their credit, the last Government were increasing spending on the health service. However, that suggests to me that the answer to improving outcomes and care is not about money. We can pour a lot of money in, but it will not do the trick. It has its role, but it is not the final driver. I hope that one of the legacies of Francis will be that we can recognise that the debate needs to move on. It should not be a bidding war between different political parties and ideologies about money. It should be about the thing that matters most: will patients get better, will they receive quality care and will they be treated with respect and dignity, come what may? If we drive a mature debate in this country, we can achieve outcomes on that basis.

As Opposition Members have said, perhaps we can step aside from politics. I am not naive and I do not believe that that will happen. However, every time we debate these matters, let us remember that we have a far greater chance of achieving what we are here to do, which is to provide a health service that is the envy of the world, if we have a mature debate. I say cautiously and with respect that in the light of Francis, our health service cannot currently be the envy of the world, but its ideals are most definitely the envy of the world. We have a duty in this place to set the standards that will make it the envy of the world once more.

I am very conscious of the time, but I would like to make one quick point. We have heard a lot about the culture, but we cannot change it just like that. Culture is thoroughly and utterly inbred within any institution. It starts with the new people it trains—that includes the people who are there now—and it touches everything that it does. Everything that an institution does should reflect its culture, and changing the culture therefore takes time.

Where I disagree with some in this House is in my belief that leadership is where culture starts. This House, managers in hospitals and trainers all have a role to play. However, every time I consider the role of the current chief executive, Sir David Nicholson, I come back to the point that although he has voiced sentiments that I welcome in that he said that to achieve care we need an open, transparent and care-led culture, that it is vital for staff to be seen as an asset, and that it is vital for staff to be able to challenge their leaders, the reality is that he is a command-and-control manager. That is his legacy and others have paid a price for it. I believe that his departure, whenever it may happen, is absolutely necessary to change the culture because we need to start at the top and feed it throughout the business. I say that with a heavy heart, because I do not believe that we should be chasing scalps. However, as I said at the beginning, we should be chasing the ultimate outcome of serving our patients and that is one way of doing it.