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NHS: Basildon and Colchester Hospital Trusts

I thank the noble Earl and the noble Baroness for their remarks. I shall try to work my way through the questions that we are addressing this evening. The noble Earl asked when Ministers become aware of these matters. He asked me exactly the same question when we discussed these issues in relation to Mid-Staffordshire. The answer is almost exactly the same; Ministers become aware through Monitor and the CQC—the regulators—that concerns are being expressed about hospitals. Indeed, both the CQC and Monitor took co-ordinated action with regard to Basildon and Thurrock trust, which included the unannounced visit. An action plan was then produced. I have been looking at the timeline of exactly what happened and in what order—I should be happy to share that with noble Lords—which shows that there was enormous co-ordination, which led to the actions that were taken. The noble Earl asked about mortality rates being out of date and whether they gave a complete picture. The HSMRs are quoted by Dr Foster, but they relate to 2008-09. Since then, the trusts’ own data—I refer to the trusts that were mentioned; I shall come back to the Dr Foster report—suggest that significant improvement has been made. HSMRs are important for alerting further investigation, but as we have discussed previously in the House, on their own they are not a sign of a good or a bad trust; they are a signal that further investigation may be needed. The noble Earl and the noble Baroness, Lady Barker, referred to the different factors that the CQC will use as we move forward into the new regime. As noble Lords know, that will kick in in April. The annual health check is not at all a tick-box exercise. It will include follow-up inspections of trusts and the analysis of thousands of pieces of information from surveys of hospital patients and of 150,000 NHS trusts and data on waiting times, access to services, cancer survival rates, treatment of stroke and heart patients, mortality rates, infection rates and information on spot checks. I assure the noble Baroness that those checks will continue and will be a very important part of the work of the CQC. The annual health check will also include information from reviews of specific issues such as safeguarding children and information from public groups such as the local involvement networks; in other words, it will be a 360 degree analysis, taking on board all the major formal and informal factors. That leads me to the point about the difference between Dr Foster and the CQC. We are encouraging a culture of openness and challenge within the NHS, particularly in relation to patient safety data. That is a good thing. Dr Foster’s report uses NHS data, but interprets them in a particular way, using a particular methodology. Some trusts are, indeed, challenging that—and that is their right. Those conversations will no doubt continue. But we set up an independent regulator precisely to be the authoritative voice in these situations. The CQC looks at a much broader range of data than Dr Foster does. It also carries out unannounced inspections, as it did in relation to Basildon and Thurrock. So we are not setting up these ways of looking at patient safety in opposition to each other; we are saying that there are different voices—many voices—which will be heard in a culture of challenge. But the CQC is the body to which we look for patient quality and standards. The analysis that it carries out is the one that we will use to establish whether or not trusts need investigation, irrespective of whether they have assured us that they are not experiencing the kind of failings that we have seen in Basildon and other trusts. While I can see why people might find that confusing, it is a sign of a healthy culture that is challenging the issues on patient safety at all times. The noble Earl mentioned Colchester Hospital University NHS Foundation Trust. On Wednesday, Monitor used its formal intervention powers at Colchester to remove the chair, with immediate effect, and appointed Sir Peter Dixon as interim chair, with effect from today. The foundation trust was found to be in significant breach of its authorisation by failing to comply with healthcare standards and to exercise its functions effectively, efficiently and economically. There were serious and wide-ranging concerns about its governance and leadership. Monitor has done exactly what it was set up to do—to deal with concerns that it had. I had anticipated that the noble Earl would raise the issue of targets. He may anticipate my answer. We have been clear that no achievement of targets or foundation trust status should be at the expense of patient safety. The targets set from the outset by this Government have reduced waiting lists and increased the speed with which people are treated in accident and emergency. We know that we need to do more, which is exactly why the proposals of my noble friend Lord Darzi in High Quality Care for All set out a vision of the next step, which is making quality the organising principle of the NHS. The noble Earl asked whether the CQC was sufficiently resourced to carry out this job. There are sufficient resources to undertake real-time assessment of providers’ quality, using self-assessment and a range of inspection tools, which I have already mentioned. The noble Earl and the noble Baroness, Lady Barker, talked about patient and staff voices. I hope that I have demonstrated that both matters are built into the continuous monitoring and assessment of hospitals and that both are very important indeed. The noble Baroness, Lady Barker, asked about healthcare-acquired infections. The results have been dramatic; we have reduced them. I am told that I should stop talking, although I wanted to deal with all the questions raised. We have done a great deal of work to support people with learning disabilities and have recently launched Valuing Employment Now. We must take, and are taking, more care in this area to support Mencap and work with it to ensure that its aims are built into the work that we are doing in hospitals.