Francis Report

Peter Bottomley Excerpts

Wednesday 5th March 2014 Commons Chamber

[Sir Peter Bottomley (Worthing West) (Con)]

It is 10 years after the trust lost its three-star rating and went down to zero. It is nine years after most people monitoring hospital performance knew what the problems were. Whistleblowing began in 2007—the Royal College of Nursing knew that, but others did not.

I should like to focus on recommendation 11 of the report that came out three and a half years ago. It deals with the candour required of staff, and it says that clinicians and their views should be represented at all levels of the hospital and the trust. A contrast to what happened at Mid Staffs is provided by a hospital in Seattle—the Virginia Mason medical centre—that decided, first, that if it made mistakes it would admit it and, secondly, that any member of staff could stop the process if there was a significant problem. I recommend a book by Charles Kenney called “Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience”, which should be read—or a summary should be made available—by virtually everyone concerned with organised health care in this country.

Some of the lessons are simple but rarely put into practice. Let me make an analogy. My brother-in-law, Christopher Garnett, ran the London to Edinburgh line for the Great North Eastern Railway, and members of staff would say that he was the only manager who got on the train and asked everyone what he could do to help make their job more effective; they were used to managers telling staff what they could do to make the manager’s job more effective.

The Virginia Mason medical centre looked at what it was doing, and it discovered that nurses spent a third of their time with patients. After changing how they worked, nurses spent 90% of their time with patients. Dr Gordon Caldwell of Worthing hospital in my constituency said that people should be in hospital only if it is doing them some good. They should have a named doctor and a named nurse, but he discovered that, probably throughout the health service—partly but not entirely because of the European working time directive—a patient’s doctor and nurse probably did not speak to each other about the patient more than once a week. That is not good enough.

There is a series of issues, but the key one is empowering front-line staff. Dr Kim Holt, a clinician and leader of Patients First, with whom I am involved, warned in advance that Haringey children’s services were no longer staffed by the right number of qualified senior clinicians. She made it plain that the baby Peter case was not just about a failure to bring together the child’s records from the different parts of the health service to which the family had taken him. She said that the locum, who ended up with all the blame, could not possibly have done the job that she was asked to do. Kim Holt suffered under her employer—the trust. She stood up to it, and would not be bought off and silenced. I pay tribute to her for that.

I could speak at length about this, but I should like to end with a request both to the people at the top of the health service in England and to Ministers. I suggest that Ministers and NHS England meet the group of clinicians that Kim Holt can bring together with Roger Kline at Patients First, listen to their stories and ask where in the process of NHS management, each complaint or disciplinary case has got to. That involves managers, nurses, midwives, doctors and others. The Department of Health should make sure that that happens, but not necessarily in public. It should ask each of the managers involved what they have done all the way through each case and whether they would like to revise what they are doing. There are still too many whistleblowers being bullied, bribed, bought off or sacked 10 years after the Mid Staffs events told us what could go on.