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Mid Staffordshire NHS Foundation Trust

With permission, Mr Speaker, I wish to make a statement on the report of the independent inquiry into the Mid Staffordshire NHS Foundation Trust, which I am publishing today. Copies have been placed in the Vote Office. In July last year, I commissioned Robert Francis QC to conduct this inquiry. I asked him to establish what went wrong at Stafford hospital and why; what lessons can be learned; and what further action is needed to ensure the trust is delivering a sustainably good service to its local population. In particular, I asked his inquiry to focus on listening to patients and their families. I said at the time that the full impact of what happened at Stafford hospital would be understood—particularly in the NHS at local and national level—only when we heard clearly the voices and experiences of those most affected. The Francis report fulfils all those aims. I wish to thank Robert Francis for his thorough report, and the painstaking way in which he has conducted this investigation. Over 900 pages and two volumes, his report lays bare a dysfunctional organisation at every level and appalling failures of basic care over the period between 2005 and March 2009. The report confirms the severity of the then Healthcare Commission's assessment of the trust in March 2009. In his covering letter to me with the report, Robert Francis says:""The overwhelming number of accounts given by those affected should surely put to rest the views, still harboured by some, that the Healthcare Commission's report painted an unfair picture of how the Trust was performing. There can no longer be any excuse for denying the enormity of what has occurred."" Let me be clear: the care provided was totally unacceptable and a fundamental breach of the values of the NHS. Since March last year the Government's first priority has been to help the trust to take immediate steps to improve patient safety, care standards and public confidence. Last July a new chair and chief executive were appointed and, with a new board and senior team, they are making progress, as confirmed by the Care Quality Commission's three and six-month reviews. However, as their local hospital hits the news again today, I appreciate that doubts about safety will be in the minds of people in Stafford. In advance of this statement, I therefore asked the Care Quality Commission for its latest assessment of both the Mid Staffs trust and the wider NHS. I will place a copy of its letter in the Library. The Care Quality Commission confirms that the trust is safe to provide services, although further improvements are still needed, and says that it does not believe that there is any other hospital in England with problems on the scale or of the magnitude seen at Mid Staffs. There have been many calls for a full public inquiry into events at the trust and the wider regulatory system. When I came into this job I gave those calls very careful consideration. In particular, I spoke to the four Members whose constituencies are served by the trust. It was clear to me that a further process of inquiry was needed to establish the full picture and to help the healing process. However, I had to balance that with not distracting the trust from the overriding need to make immediate improvements in patient care. It was that consideration which led me to establish the inquiry in the form that it has taken, rather than as a full public inquiry. I did not believe that a lengthy, adversarial inquiry would be in the best interests of health care in Staffordshire. The chairman was able to ask me for further powers if he felt they were needed, but he did not do so, and I believe that his report supports the approach that we have taken. He concludes:""I am confident that many of the witnesses who have assisted the Inquiry by written or oral evidence would not have done so had the Inquiry been conducted in public."" More than 900 members of the public and 82 current and former members of staff contacted the inquiry directly or indirectly, and 113 witnesses gave oral evidence. That evidence revealed an organisation with a culture""not conducive to providing good care for patients or a supportive working environment for staff"." The board did not consider patient complaints, clinical governance or quality at its meetings. Meetings were held in private, and Robert Francis describes the organisation as working in isolation from the wider NHS community and as having a closed culture. As he has said today, the board""lost sight of its fundamental responsibility to provide safe care."" That dysfunctionality extended to the way targets were managed in the trust and the failure to put in place adequate staffing levels to provide safe patient care. The management of the trust cut staffing to dangerously low levels, at one point leaving A and E with a third fewer nurses than were needed to provide safe care. A work force review in March 2008 disclosed that the trust needed to increase its nursing establishment by 120 whole-time equivalents. There was an intimidating and bullying management style. Among staff there were failures of professional standards and clinical leadership. Some staff were praised, but the report finds a "lack of compassion" and an "uncaring attitude" among others. Time and again throughout the report, there are unacceptable examples of poor care, neglect and disregard for patients' dignity. At times, as Robert Francis says, that could be described as rudeness, hostility or even abuse. The trust has already taken disciplinary action to hold individuals to account. The trust and the professional regulatory bodies, the General Medical Council and the Nursing and Midwifery Council, are investigating a number of clinical staff potentially implicated by those events. Today I have written to the chairs of both bodies to ask them to consider the report in detail and work with the trust to determine whether further action is needed against any individuals. I have asked for their response by 12 March. In total, Robert Francis makes 18 recommendations. Together with the new board of the trust, the Government accept all the recommendations in full. I will take the four recommendations that apply to my Department in turn. First, Robert Francis recommends that I consider steps to improve accountability among executive and non-executive directors of trusts. The board that presided over the failings at Mid Staffs has been replaced, and other managerial staff have been suspended. However, it is a long-standing anomaly in the NHS that the robust professional regulatory system for clinicians is not matched by a similar scheme for managers and non-executive directors. We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere. That is not acceptable to the public and not conducive to promoting accountability and high professional standards, so today I am announcing that I will consult on a new system of professional accreditation for senior NHS managers. Secondly, Robert Francis asks me to consider asking Monitor to de-authorise Mid Staffs as a foundation trust. The report makes it clear that Mid Staffordshire has not been deserving of the foundation trust status that it has held for the past two years. At the same time as setting up the inquiry, I proposed to create a new power for Monitor to de-authorise foundation trusts, to make it clear that this status has to be continually earned and is not a one-way ticket. That provision was subsequently endorsed by this House. I can tell the House today that I accept Robert Francis's recommendation to consider asking Monitor to de-authorise Mid Staffs. My strong view, in the light of the report and the support that the trust is likely to need in the medium and long term, is that I will ask Monitor to consider de-authorising when the powers come into effect in the coming months. I will therefore ask the CQC, Monitor and others to give me their views of the trust's long-term clinical and financial prospects, and I will consider initiating the process in the light of their responses. Thirdly, Robert Francis asks me to review how comparative mortality statistics are compiled, as well as the methodologies that underpin them, to improve public confidence in and understanding of them. One of the principal reasons why the Healthcare Commission launched its review in 2008 was that it was not satisfied with the trust's explanation of its high hospital standardised mortality ratio. The inquiry has consulted a range of experts on the issue, and Robert Francis concludes:""it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number or range of numbers of deaths were caused or contributed to by inadequate care"." However, as he points out, there is no shared methodology for HSMRs, nor any clear account of how they should be used and interpreted. The result is confusion for patients and the public. I therefore welcome and accept the recommendation to establish an independent working group to examine and report on the methodologies in use. The NHS medical director, Professor Sir Bruce Keogh, has already established that group, which includes the key parties involved in developing and using HSMRs, as well as leading academics and others. The group has committed to developing a single HSMR for the NHS. Fourthly, the report calls for a further independent examination of all the commissioning, supervisory and regulatory bodies, in relation to their monitoring role at Stafford, with the objective of learning lessons about how failing hospitals are identified. I accept that recommendation, and can tell the House that Robert Francis has agreed to chair the further inquiry. We are publishing draft terms of reference today, and we welcome views on them. In addition to accepting all the report's recommendations, there are further steps that I will now take to learn the lessons of this and prevent a repeat. First, let me make clear today to all foundation trust boards my strong presumption that their meetings should be held in public and that governors should have access to all papers in the trust. The decision of the board at Mid Staffs to hold more meetings in private on achieving FT status is a direct contradiction of what this House intended when it passed the original foundation trust legislation. Secondly, I am today accepting the National Quality Board's recommendations to improve early warning systems in the NHS, and I am publishing its report today. Thirdly, a group has been established to advise me on updating whistleblowing guidance. Statutory protection for whistleblowers is enshrined in the NHS constitution, but events at Stafford hospital reveal the need to ensure that staff feel able to exercise that right. Fourthly, I want to see a much greater focus in the NHS on measuring patient satisfaction and staff satisfaction—key indicators of good quality care. In December, I announced that a growing proportion of a hospital's income will be linked to patient satisfaction, rising to 10 per cent. of its payments over time. Fifthly, I brought forward the new system of provider registration in the NHS to ensure essential levels of safety and quality. The CQC has already announced today its intention to register Mid Staffs, although it will place conditions where further improvement is needed. In conclusion, the Francis report delivers a damning verdict on a dysfunctional organisation. It was principally a local failure, but I accept that there are national lessons to be learned—and they will be. Last year, the Prime Minister apologised to the people of Staffordshire. On behalf of the Government and the NHS, I repeat that apology again today. They were badly let down. I pay tribute to the people who had the courage to come forward and tell their stories and to expose the failures of the past, in order that they could protect others in the future. Robert Francis said that many of the patients who gave evidence to the inquiry""were motivated because they do care about the hospital, and demonstrated by their actions that they can be a part of mending the fractured confidence."" That sentiment is shared by all those who came forward, and indeed by the majority of people who complain about the NHS. They do so because they want it to be better. I want their voices to be heard loudly and clearly in this trust, and across the NHS. Today, Sir David Nicholson has written to every NHS chief executive and chair, urging them to read this report and to review their standards, governance and performance in the light of it. When the NHS fails—as it did the people of Staffordshire—it is right to confront it with its failings. At times, there is a tendency in the NHS to push complaints away. I believe very strongly that it is only by facing up to failure—and by holding a mirror up to the NHS—that we can ensure that it is a learning organisation and prevent any repeat. Since events at Stafford, Lord Darzi's next stage review has established a major drive to build an NHS that places a relentless focus on quality. For the vast majority of patients, the NHS provides a good standard of care. The CQC's latest patient survey showed that 93 per cent. of patients rated their overall care as good or excellent. When things go wrong, however, we must face up to them and do everything in our power to ensure that such events can never happen again. I commend this statement to the House.