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NHS: Basildon and Colchester Hospital Trusts

My Lords, the House will be grateful to the Minister for repeating the Statement. The fact that positively glares at us as we listen to this very disturbing announcement is that the deficiencies evident at these two hospitals are not newly discovered findings. They have been known about for many months and, in the case of Basildon and Thurrock, for at least a year. Although we are told that there has been progress in that hospital since then, when the CQC inspected the trust, it clearly uncovered deeper failings which it deemed sufficient to trigger a complete change in the clinical leadership. That lack of clarity and transparency as to the true situation at the trust prior to the CQC inspection is extremely concerning. When did Ministers first become aware that things were seriously amiss at Basildon and Thurrock as regards its poor standards of nursing and infection control? Was there an opportunity to get to grips with the situation sooner? If press reports are right, there were concerns about Basildon as far back as 2001, when the RCM described conditions there as "third world". There have been several disturbing reports about the trust since then. In passing, I wonder why the hospital has the word "University" in its name. It is a word that tends to give a misleading impression to the public. As regards Colchester, we understand that the action taken by Monitor did not relate to hygiene standards, but higher than average mortality rates were a factor along with deficiencies in management and leadership. Will the Minister give us any further details to put the drastic action taken by Monitor into better context? It is reassuring to hear that the CQC does not believe that similar action is called for elsewhere in the NHS, yet at the weekend Dr Foster published data which tended to suggest that that assessment might be premature. I was unclear about what the Minister was saying about Dr Foster's findings. Was she saying that the mortality figures quoted by Dr Foster were out of date, or that they failed to give a balanced picture of the overall standard of care in those trusts? If it is the latter, it seems odd to presuppose that the so-called wider view offered by the CQC is inherently more valid than performance measures that focus on individual factors or areas of activity such as mortality rates. I am not sure of what Dr Foster stands accused. Equally, it seems strange to seek to excuse hospitals of apparent poor performance on the grounds that the overall trend in performance across the NHS is improving and that in any case everything is relative. That smacks of defensiveness on the part of the Government. In fact, it steers perilously close to complacency. In a debate of this kind it is easy to sound negative about clinical standards across the entire NHS. I do not for a minute wish to do that because I am personally aware of many superbly run hospitals which deliver a standard of care second to none. Nevertheless, we have recently had a string of announcements about poorly performing hospitals, each of which has been characterised as an isolated case, such as Stoke Mandeville, Maidstone and Tunbridge Wells, Mid Staffordshire and, now, Basildon and Thurrock. The mix of failures at each hospital is unique, but there are recurrent common themes: waiting time targets prioritised above safety and hygiene; a focus on financial issues and ticking boxes at the expense of quality in patient care; and senior management showing a lack of proper leadership, with front-line staff finding that their concerns are not being acted on. I worry that the assessment methodology that the Healthcare Commission relied on, of self-reporting by trusts and prearranged inspection appointments, has not delivered a true picture of those trusts whose standards have subsequently been shown to fall well below what is acceptable. Does the Minister agree that the assessment methodology to be adopted by the CQC needs to move away from that model and to rest much more on what patients actually experience during their time in hospital and on unannounced inspections? Will that be done? If so, how will it be done? For example, what system can be put in place to enable the CQC to monitor patterns emerging from complaints and from hospital outcome data rather than from how well or badly a hospital is adhering to process-based targets? How can we ensure that the concerns of front-line staff are listened to rather than swept under the carpet? Finally, I was a little surprised to hear that the CQC feels that it is currently in a position to accelerate the introduction of what the Statement describes as the, ""in-depth analysis of trust performance in real time"." Is it sufficiently resourced to do that earlier than next April? Something tells me that we shall return to these matters on future occasions, but in the mean time, it is right to wish both Monitor and the CQC well in fulfilling their respective roles.