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Hospital Trusts (Essex)

With permission, Mr. Deputy Speaker, I wish to make a statement on patient safety in the NHS. Last week, the two regulatory bodies took action in respect of two NHS foundation trusts, Basildon and Thurrock University Hospitals NHS Foundation Trust and Colchester Hospital University NHS Foundation Trust, and I wish to update the House on that. Separately, questions have been raised about safety standards at other NHS and foundation trusts. I wish to answer those directly and inform the House of the further steps that the Government are taking to improve regulation and safety standards in the NHS. First, let me set out some important points of context. In 1999, the Government established an independent regulator for the NHS. In tandem, the Department of Health has sought to shine a spotlight on patient safety in the NHS over the past decade by encouraging the systematic publication, analysis and comparison of a range of clinical data. That followed the Kennedy inquiry into events at Bristol. That drive has brought more transparency and a greater focus on safety standards. At all times, patient safety is our overriding concern, and there are signs of significant progress in the NHS as a whole. Overall, there was a 7 per cent. reduction in the hospital mortality rate in England last year. However, there is never any room for complacency, and patient safety must be the subject of a continuous process of improvement. There is still considerable variation in standards throughout the NHS, from one hospital to another, and in some cases the variation is unacceptably wide. That is the case in respect of Basildon and Thurrock University Hospitals NHS Foundation Trust. A year ago, surveillance of data by regulators identified a high hospital standardised mortality ratio at the trust. Since then, the regulators have worked with the trust on a detailed improvement plan. That focus had brought improvements, and over the course of this year the HSMR has fallen. However, following unannounced inspections, the Care Quality Commission has raised further concerns with the foundation trust regulator, Monitor, about care standards and the rate of improvement. They agreed that progress was not sufficient, and it was felt that the trust was unable to deliver the improvements necessary within an acceptable time scale. A decision was therefore taken to intervene and use formal powers by installing new clinical leadership at the trust. Two senior professionals from high-performing trusts will provide experienced medical and nursing support to ensure the early implementation of agreed clinical and nursing changes. A programme delivery office has also been established to oversee delivery. I can assure the House that, as a result of this action, I expect to see immediate improvements and will provide regular updates on progress. Monitor has also taken action in recent days in respect of Colchester Hospital University NHS Foundation Trust. Last Friday, the regulator used its statutory powers to remove the chairman of the trust. Monitor had, over a period of time, raised a series of concerns with the trust in relation to performance and governance. It has concluded that those have not been adequately addressed and decided that new leadership is necessary to bring the improvements that patients have a right to expect. I wish to make it clear to the House that the CQC has informed me that no similar action is necessary at any other trust at this stage. As part of regular monitoring, however, it has identified a small number of other trusts where action is needed to address concerns, and over the weekend there has been further analysis of safety in the NHS. Twelve NHS and foundation trusts have been claimed to be "significantly under-performing" in relation to safety, and a number have a high hospital standardised mortality ratio. While I welcome the shining of a spotlight on to safety standards, it is important to place this finding in context. Given that deaths in hospital have reduced overall—by 7 per cent.—it is possible that the trusts with a high rate are not showing the same level of improvement as the rest. That said, it is vital that these questions are investigated and answered. It is also important to point out that the report by Dr. Foster analysed a more limited set of clinical and quality data than the CQC. The CQC therefore provides the authoritative voice on these issues, and takes a wider view. The report highlights a number of trusts where there have been issues, but many had already identified them and have action in hand. I can assure the House, however, that where legitimate concerns have been identified, they will be followed up. Again, I will provide updates as and where necessary. Patient safety must at all times be the highest priority for my Department, the national health service and every single hospital in the country. I expect every trust in England to investigate all serious incidents and unexpected deaths and report them to the national reporting and learning system. This will be mandatory as part of new registration requirements. Following events at Mid-Staffordshire hospital, hospital standardised mortality ratios for all hospitals in England have been published on NHS Choices since April 2009. From next April, the CQC will introduce a stronger inspection regime that provides an in-depth analysis of trust performance in real time. This will also be available online for the public to inspect. However, as a result of concerns expressed, I have asked the Department to speed up the implementation of this new system and will bring it in from January. Already, 90 per cent. of CQC inspections are unannounced. I wish to see this at least maintained in any new system, with more unannounced visits at trusts giving cause for concern. All trusts will soon be required to screen for MRSA when admitting patients through accident and emergency. Many already do, but I am asking the Department to speed up 100 per cent. adoption. I will also shortly bring forward plans to link hospital payment more closely to safety and quality. Lord Darzi's next stage review made it the mission of the NHS to focus relentlessly on safety and quality. All trusts must constantly review performance and, where necessary, raise their game. Progress has been made, but where it is not quick or good enough we will always say so and act swiftly. I commend the statement to the House.