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NHS: Basildon and Colchester Hospital Trusts

My Lords, I, too, am grateful to the Minister for repeating the Statement made in another place earlier. Before turning to the substance of that, I also wish to acknowledge the tremendous amount of very high-quality work done in most hospitals and trusts throughout the United Kingdom. It is always tempting when there is an incident of this kind to lose perspective and work it up into something with which to create panic. I do not believe that we should do that. It is our job as responsible parliamentarians to look at the facts in context and abstract from them relevant conclusions. That said, at the time of the revelations about failures at Mid Staffordshire and in light of the failures at Tunbridge Wells, both of which were trusts approved by the CQC, my colleague in another place, Norman Lamb, said that it was time to look at the role of regulators. In view of these two latest incidents in Basildon and Colchester, there is an even more compelling case to look at the role of Monitor, sitting as it does alongside the CQC, and the interventions of Dr Foster. As the noble Earl, Lord Howe, observed, there remains a suspicion from all the reports into these incidents that the role of targets is detrimental to clinical priorities. Time and again, in each of the reports, staff make the point that they are having to change their practice to ensure that the hospitals meet targets and fulfil those things that are more likely to be monitored. These may not necessarily be the things that are in the best interests of patient care. The Statement repeated by the noble Baroness mentions the number of unannounced visits. All noble Lords present this evening were also present during the passage of the Health and Social Care Bill when we debated at length the role of unannounced visits. I take little credit, but I remind noble Lords that that was a point which some of us felt was essential to rooting out poor practice. I, too, ask the Minister whether she can confirm that the CQC, in meeting the accelerated timetable, will continue to have the resources to conduct unannounced visits in all trusts. It is also worth noting something that was not in the Statement but is none the less important. In Basildon and Thurrock, it was Mencap which drew to people’s attention the fact that four of the people who died had learning disabilities. That happened as a result of Mencap’s campaign, Death by Indifference, which has focused attention on poor clinical services being received by people with learning disabilities. I ask the noble Baroness whether, in the programme of work to bring about change that she has outlined, care of people who have learning disabilities will be part of the improvement. I will focus briefly on what is at the heart of many of the problems. There are three different bodies, each producing information about the quality of work in trusts. There is CQC, Dr Foster—an organisation co-owned, incidentally, by the Department of Health—and Monitor, each producing its own ratings. Just this last weekend, Dr Foster produced a report which indicated that 12 trusts were in the lowest of its five bands of rating for safety, but one of those—St Helens and Knowsley—has been rated as excellent by the CQC. It seems rather strange that we have three different bodies, each producing vastly differing assessments of what is going on in the same hospitals. In January 2008, Monitor, in its evidence to the Health Select Committee in another place on the Health and Social Care Bill, said: ""The requirements to meet national standards and targets and monitor and improve quality are a significant element in the Terms of Authorisation"—" for a foundation trust. It continued: ""We have developed a detailed approach to ensuring compliance with these elements of Authorisation. We are working closely with the Healthcare Commission"." Monitor went on to say: ""For example we have worked successfully with the Healthcare Commission on specific investigations of clinical performance, The Health Protection Agency and the Department of Health on Healthcare Associated Infections and independent auditors on waiting time management. We believe this has provided a robust regime for assuring quality in NHS foundation trusts and should form the basis of the regime going forward"." Does the Minister agree that that was perhaps misplaced optimism on the part of Monitor and that, in light of these events, following events in Mid Staffordshire and Tunbridge Wells, it is now time to have a look at the inspection regime in order to bring clarity and consistency to the three different bodies monitoring hospitals? Does she further agree that the criteria for that ought to be to ensure consistency in patient safety and to restore the confidence not just of the public but of the NHS professionals who work in those institutions and who have a right to know that their hospitals are good?