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Hospital Trusts (Essex)

Volume 501: debated on Monday 30 November 2009

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.

I am sure that the House is grateful to the Secretary of State for making a statement about these two interventions at NHS foundation trusts, notwithstanding the fact that he is not directly responsible for what happens in those trusts. However, if he is going to take some responsibility, can he explain what he did on or after 4 November, when the inspection report into the prevention and control of infections at Basildon and Thurrock was published on the CQC website, including many of the findings that have subsequently caused so much distress to the patients and public around Basildon and Thurrock? Was Thursday’s press release about the intervention by Monitor merely a sacrificial lamb ahead of the Dr. Foster report?

Now that the taskforce has gone into the Basildon and Thurrock trust, does the Secretary of State agree that it is vital that, within days, it advises Monitor on whether the trust has, or does not have, the necessary leadership, clinical and otherwise, to take it forward for the future?

Earlier this month, Monitor made it clear that it was considering intervention at Colchester because the trust appeared to have breached the terms of its authorisation. Did the Secretary of State have any correspondence with Monitor about that, and did he have a view about it at the time?

In his statement today, the Secretary of State seems to have been talking almost interchangeably about the CQC and Monitor, but it will be evident to many, as it was to me, that they were not speaking from the same page in relation to Basildon last Thursday and Friday. Will the Secretary of State, like me, make it clear to the CQC and Monitor that the relationship between those two regulators will have to be closer and more harmonious than it has been in the past if it is to work effectively?

The Secretary of State’s statement centred on two individual trusts, but the repercussions will be felt across the country, not least because of the worrying data in the Dr. Foster report, none of which should come as any surprise to the Secretary of State. However, instead of listening to the messages in the report, the Government set out over the weekend to shoot the messengers. They are quite wrong to do so, and that will not restore public confidence.

What is required, I am afraid, is evidence that the Government learn from the lessons of these serial failings. Why do I literally have to stand at this Dispatch Box again responding to issues very similar to those we saw at Maidstone and Stafford? Ministers each time call it an isolated case; each time they say, “We mustn’t be complacent and it must never again happen”; but each time they fail to tackle the heart of the problem.

We know that the NHS is capable of delivering some of the best health care in the world; we know that some hospitals—such as my own, Addenbrooke’s, in Cambridge—are among the best in the country and do remarkably well. However, to understand why some hospitals do not deliver acceptable standards, we just have to look at the lessons of the recent past: Stoke Mandeville, 2006; Maidstone, 2007; Mid Staffs, March this year; today, Basildon and Thurrock trust. Recurrent themes have occurred in each of those hospitals: waiting time targets prioritised over patient care; clinical priorities distorted by Government targets; a focus on financial issues at the expense of patient care; senior management at board and strategic health authority level prioritising national targets and policy objectives over the delivery of quality care for patients; primary care trusts focused on the cost and volume of treatments, rather than performance management of the quality of care for their public; and a lack of leadership and accountability, with front-line staff finding that the concerns they have raised are not being listened to.

When will the Secretary of State acknowledge that the Government must do something about this, and in particular scrap the top-down process targets that divert attention away from patient care towards tick-box questionnaires? It is clear that, where the regulatory system is concerned, the Government will have to abandon the health check published by the CQC last month. Will the Secretary of State agree that he should do so and instead have a rating system that actually relates to what patients experience in hospital and the results of the treatment they receive; that is based on outcomes, not processes; that has more on-the-spot inspections; that is based on patient experience and their reports of their outcomes; and that follows up unresolved complaints?

Another reform is to give patients and the public the power to influence how care is provided in the NHS. The Government scrapped community health councils and have never since allowed there to be an effective patient voice in the local community. Will the Secretary of State ensure legal protection for staff who blow the whistle on failings in their trusts, and that the NHS adopts, as it must, a “no-blame” culture in which the penalty is for the cover-up, not the error?

The public need to be assured that the Government are doing all that can be done to ensure the safety of patients in our hospitals, but today, how can they be? We have conflicting analyses from Dr. Foster and the CQC. We have Ministers out of their depth and in denial. We have an NHS that has the capacity to deliver the best, but with neither the incentives nor the leadership in place to make it happen. What did we get from the Secretary of State? We got processes, rather than purpose, and another statement that “this must never happen again”. It is just not good enough.

I will deal with the hon. Gentleman’s questions in turn, but let me deal first with his last point. I think he was accusing us of complacency, or of failing to address directly the issues that matter to patients. Ever since coming into this job, I have said that I do not want to over-claim for the NHS. Where it is good we should say so, but where there needs to be improvement, we will not flinch from taking the action necessary to get it.

It is important for the hon. Gentleman to acknowledge that the data on which the judgments in question are being made have been encouraged by this Government, following some of the events that he mentioned. The culture of challenge and analysis of clinical data has been at the heart of our plans for improving the NHS, which is why what he said was unfair and misdirected. It was this Government who asked the regulators to use the HSMR data to ensure that there was challenge. Because the Healthcare Commission, the predecessor to the CQC, was looking at those data, it was able to take the action that it did in relation to Mid Staffordshire.

I will always accept hearing from the hon. Gentleman that we can do more and should not be complacent, but I point out to him that there is no complacency. We have made changes, and thinking back to what was in place before, I do not believe that it was possible to make judgments about the clinical standard and safety of care across the NHS, as it is today.

I shall deal with some of the hon. Gentleman’s specific points. He particularly asked me about 4 November, when the report was submitted by the CQC. He has to accept that, as I said in my statement, the matter goes back further than that. Because of the system of regulation that we have, and because there is routine monitoring of data, action had been taken much earlier and the two regulators had been in contact about Basildon and Thurrock NHS foundation trust. Action was in hand and a plan had been developed, and it was because the regulators felt that progress against that plan had not been sufficiently swift that they decided to escalate their involvement. It is not fair of the hon. Gentleman to say that there was a knee-jerk response, because there had been a long process in place that had failed to produce the necessary improvements, and an unannounced visit by the CQC in October highlighted some of the concerns that then required the escalation.

On Colchester, the hon. Gentleman will know that Monitor has been expressing concerns about standards for some time and has been in dialogue with the trust. I support the regulator, in this case Monitor, in taking the action that it believes is necessary to improve standards for patients quickly. I shall make no apology for that.

The hon. Gentleman mentioned the relationship between the CQC and Monitor, and I agree that there needs to be close co-operation between the two regulators. I accept that there were lessons to be learned following the events at Mid Staffordshire about how that relationship could be improved, and I accept that he is right to say so, but there has been close co-operation on Basildon and Thurrock, and that has led to the action that I have described.

On Dr. Foster, the hon. Gentleman asked, “Why shoot the messenger?”, but I do not believe that the Government did that. As I said, we have encouraged the publication of the relevant data across the NHS. He needs to take a step back, if he does not mind my saying so, because the patient safety rating in this case is disputed by some of the trusts in question. He will have seen yesterday that some of them issued a pretty strong rebuttal to the concerns raised, and that is all part of the process of challenge. We did not dismiss the Dr. Foster findings; indeed, it was on the back of those concerns that I asked to be assured that no action similar to that taken at Basildon and Colchester needed to be taken against any other NHS trust. I received that assurance from the chair of the CQC over the weekend.

As he always does, the hon. Gentleman made a big criticism of Government targets and suggested that they run counter to improving patient safety in the NHS. The best hospitals are meeting performance standards targets that matter to patients and financial targets, and providing high-quality, safe care.

Is the hon. Gentleman really saying that A and E departments were safer before the introduction of the four-hour target? I am not sure that he wants to make that claim. I remind him—it almost seems to have slipped his memory and that of his colleagues—that the patients charter circa 1995 included a four-hour A and E standard, and a proposal to reduce that target to two hours once it had been embedded. I do not therefore believe that it is possible for Conservative Members to stand at the Dispatch Box and claim that setting such targets is the wrong thing to do.

The hon. Gentleman mentioned the need for patient feedback and I agree that there is a need for better feedback from patients about the standards of care that they receive. That is why we introduced NHS Choices, with the ability for patients to put their comments online. However, I agree about the need for better patient satisfaction data, service by service, throughout the NHS. I have said that I want that published systematically, and a new link to payment for hospital services.

I assure the hon. Gentleman that there is legal underpinning for whistleblowing throughout the system, and we should all do what we can to support staff who want to raise concerns about standards in their workplace.

I thank the Secretary of State for sight of the statement before he came to the House.

It is important to acknowledge the fine work and standard of care across most of the NHS. Indeed, there will be many fine clinicians doing important work in the hospitals that we are discussing, so it is important not to tar everyone with the same brush.

However, the revelations raise serious concerns. For example, a taskforce has been sent into Basildon, but will we get to the bottom of how the failures occurred in both hospitals so that we understand who was responsible? What about the clinicians? Each has a duty to their patients. Will they be held to account for any failures? What about the people on the board who have responsibility for patient safety? Will they be held to account?

The CQC says that there is no evidence of another trust’s being in the same category as Basildon and the Secretary of State repeated that assurance. Yet that is precisely what we were told in the aftermath of Mid Staffordshire—that it was an isolated incident. How can we have faith in the CQC’s standards given what happened with Mid Staffordshire?

Are Dr. Foster’s concerns being thoroughly investigated, particularly the extraordinary statistic that 39 per cent. of hospitals have failed to investigate all unexpected deaths or cases of serious harm? Surely every case must be thoroughly investigated.

There is now a series of cases in which there is an extraordinary mismatch between rating and the reality: Mid Staffordshire, baby P, Basildon; and eight of the 12 cases that Dr. Foster raised were rated good or excellent. Does not that completely undermine confidence in the system of regulation? Do not we end up with a state of paper safety, but not real patient safety?

The Secretary of State will know about the NHS Confederation report “What’s it all for?”, which is a damning critique of the system of regulation in this country. It highlights that more than 60 bodies inspect hospitals, with no clinical engagement in responding to all those organisations. One person would take 491 years to provide all the data to the national regulators. What has happened to that report? Are the Government ignoring it or acting on it? If they are acting on it, how are they doing that? The report highlights that several bodies nationally are responsible in some way for patient safety: the CQC, Monitor, the National Patient Safety Agency, the Health and Safety Executive. Who is ultimately responsible? Is there not a danger that no one ends up being accountable?

We hear that Monitor has a list of 11 NHS foundation trusts where there has been a significant breach of standards, which it is investigating. The CQC is investigating a few hospitals. Dr. Foster has concerns about 12 hospitals. Are they all the same hospitals? Are the different bodies talking to each other? Have the local primary care trusts been informed in every case? Do not the public have a right to know which those hospitals are?

Does the Secretary of State agree that ultimately openness and full information are more effective at driving up standards than tick-box self-assessment, without clinical engagement? Does he agree that it is hard to justify the increase in the pay of the chief executives at Basildon and Colchester by 15 per cent. and 11 per cent. to £150,000 when serious concerns were being raised about standards?

Given the accumulation of evidence and the fact that hundreds of people appear to have lost their lives unnecessarily, is not there a case for an independent investigation of regulation to consider its role, self-assessment, the lack of clinical engagement in providing data to the regulators, the role of targets—yes, they must be investigated—and that of financial incentives? Do we not owe it to all those who have been affected by the scandals?

We certainly owe it to every patient in the country to take these matters with the greatest seriousness, and that is of course what we will do.

The hon. Gentleman made some sweeping statements about the numbers of deaths. It is important to say that the hospital standardised mortality ratio is a trigger for investigation, but I would caution him against thinking that in and of itself it gives a verdict on hospital performance. It is very important—and only fair to people working in the national health service—that we think of it in those terms. The ratio can raise questions and concerns that need to be addressed, but we should not treat it as a verdict on performance, because it is not that.

The hon. Gentleman began by saying fairly that a good standard of care is being provided across the NHS, and it is right to remember that in moments such as this. There are 14 million hospital admissions every year and, as we have said many times, patient satisfaction with the NHS is running at historically high levels. He asked me how failures occur. Obviously, in respect of Basildon and Thurrock, that is now the subject of detailed work, and I will update the House as and when I have more information to give.

In respect of this case, and that of Colchester, it is important to say that the regulators have said that it is not in the same category as Mid Staffordshire NHS foundation trust. It is important to make that distinction. However, that is not a recipe for complacency and it is crucial that the questions raised are properly investigated and conclusions reached and disseminated. I assure the hon. Gentleman that that is what will happen in this case.

The hon. Gentleman asked whether every case should be investigated, and he referred to the Dr. Foster data in that regard. I agree with him that those are very important and I, too, would want to ask further questions about those data and how that finding was reached. He should know that it is a requirement of the National Patient Safety Agency for every serious incident or death to be investigated, and I reiterated that point in my statement this afternoon.

The hon. Gentleman questioned the role of all the different bodies commenting on such matters. After the creation of a culture of challenge and benchmarking and the use of data across the system, it is inevitable that there will be many voices in this debate, but the Care Quality Commission is the authoritative voice that this House should listen to. It was set up by Parliament to provide authoritative advice on such matters.

The hon. Gentleman also questioned the process of self-assessment as used by the CQC. That will be the bedrock of any regulatory system, but he will know that the CQC overlays that with a range of other measures and data that it receives from a range of sources. It is that 360° analysis of what is happening at any particular hospital trust that triggers its decision on intervention.

The hon. Gentleman also asked about pay. I acknowledge the concerns that people have about excessively high pay across the public sector, but particularly in the national health service. I know that he speaks for many people in voicing those concerns. Of course the boards of foundation trusts are independent of Government, but we wrote to them some months ago to remind them that they should set pay in accordance with wider pay trends in the public sector and, at a time such as this, they should at all times show restraint in setting awards.

My right hon. Friend the Member for Basildon (Angela E. Smith) wanted to be here but she is in Committee. However, although I have been working closely with her over the weekend, my question is my own.

The question that I want to ask is this. Monitor tells us that there has been a “significant breach” in the terms of the authorisation of the foundation trust at Basildon and Thurrock, citing

“a poor care environment in A&E…inadequate arrangements to treat children…breaches of infection control,”

high morbidity and mortality rates, and general problems with health care standards and governance. Does the Secretary of State share my view that it is incredible, untenable and unacceptable that the chief executive has not decided to step aside? I include in that some other executive directors, particularly the one charged with ensuring oversight of and compliance with the cleaning contract. There is a question of public confidence in Basildon and Thurrock. Basically, Monitor and the Secretary of State need to address it with some urgency. It is unsustainable that the people who have been found by Monitor, in the words that I have quoted, to be in such significant breach should still be in post this afternoon. I understand that there is a problem—

Order. The hon. Gentleman has more than made his point—and I think that he did ask a question in there somewhere.

I heard one, Mr. Deputy Speaker, and I respect the fact that my hon. Friend was speaking for our right hon. Friend the Member for Basildon too in this regard.

My hon. Friend is right to say that every possible step must be taken to improve standards, but the test that Monitor must apply—I met Monitor last week and discussed this in detail—is: what action is most likely to achieve the quickest improvement and turnaround at the trust? That is what matters, I would say, to his constituents and those patients served by the hospital. The judgment is: how can the trust get improvements as quickly as possible? In this case, Monitor’s judgment was that action was needed to strengthen the clinical leadership in the trust—both the medical and nursing leadership—but that standards were likely to improve more quickly by keeping the action plan that had been developed under the leadership at the trust. Monitor assured me that the action plan that had been developed was a good one, but said that it did not believe that progress on it had been sufficient to date, hence the need for the escalation of its activities.

I hear my hon. Friend’s further concerns about the cleaning contract at the trust. I am afraid that I do not have a specific answer to give him today, but I will write to him in detail on that matter.

I am very sorry to tell the Secretary of State that the situation with Monitor is not quite as he described in his statement. Monitor has had concerns about the level of mortality in Basildon for more than a year, but its intervention was slowed down because, in its words, it is complicated and difficult to intervene. My constituents deserve something better than to be held back by a process that has become complicated and difficult. After Mid Staffordshire, “complicated and difficult” is not a reason for non-intervention.

I hear what the hon. Gentleman says. I asked the same question of Monitor and the CQC last week, which was: when were the concerns identified and has there been improvement? I am assured—I will write to him with the figures—that there has been a discernible improvement on the mortality ratio at the trust over this year. I will give him the figures that indicate that the plan that had been developed, which I referred to in my answer to my hon. Friend the Member for Thurrock (Andrew Mackinlay), is having some effect. Nevertheless, I hear what the hon. Gentleman says about whether that improvement has been speedy enough. That was why a decision was taken to escalate the action. There has been a significant focus on the trust over this year, which suggests that the regulatory regime picked up the concerns at the trust. I expect to see immediate improvements as a result of the actions that have now been taken, and will report to all hon. Members on those improvements as they follow.

Since the House rose for the summer recess, I have received extensive cardiac treatment at Lewisham hospital and a bypass operation at King’s College hospital in September. The service that I received throughout that period, and which I continue to receive, has been exemplary. As a beneficiary of the services of the NHS, I cannot speak highly enough of the services in south-east London, which brings me to the Dr. Foster analysis. When I was at University Hospital Lewisham just this morning, as part of my rehabilitation programme, I took the opportunity to speak to the chief executive and the chairman of the trust. They are at some loss to understand how on the basis of the same data, both the Care Quality Commission and CHKS, the leading independent-sector supplier of health intelligence, managed to find it good, with CHKS putting it in the top 40 performing hospitals in the—

Order. I am reluctant to interrupt the hon. Gentleman, but perhaps he would now put a question to the Secretary of State.

What action can my right hon. Friend take to ensure that people are not given conflicting information on the basis of the same data, which serves only to undermine the NHS and the people who work in it?

I am grateful to my hon. Friend for that question and I note his praise for the staff at both King’s College and Lewisham hospitals, who will hear his kind words. It is important that my hon. Friend speaks in that way, because at moments like this, there is a tendency to cast a cloud over all the people working in the NHS, yet, as we all know, the vast majority of our constituents receive outstanding care from the NHS and it is crucial that these issues are at all times kept in context.

Contrary to what the hon. Member for South Cambridgeshire (Mr. Lansley) said, I am not shooting the messenger. Nevertheless, the safety ratio used for this piece of research is a new calculation and, as was rightly said, there has been some challenge to that calculation by a number of hospital trusts. I think that it is a healthy thing that there is a process of challenge in respect of these matters of the utmost importance, but I would also defend the right of hospitals around the country to counter suggestions if they believe that they give an unfair portrayal of the standards at any particular trust.

It is not just the safety ratio that some trusts have challenged. The Health Secretary will know that the South Manchester trust has flatly rejected some of the factual findings in the Dr. Foster report, particularly with regard to being accused of leaving foreign bodies in patients after surgery. It says that there is no evidence of that having happened at all at the trust. Will the Secretary of State rapidly give a clear statement to the House setting out where there have been factual errors in the work that has been done?

The hon. Gentleman is right to refer to the strong words from South Manchester NHS trust. I do not think that there is any debate about the data that have been used, although there is some debate about the methodology that has then been applied to those data and the resulting scores. For instance, if we look at the Basildon and Thurrock trust, we see that it scored within expected limits on nine out of the 13 measures looked at by Dr. Foster, and it scored 98 out of 100 on one of them. I do not draw attention to that in order to dismiss the work that has been done, but it is nevertheless a complicated picture and it is not entirely clear why a score of 0 out of 100 was merited. It is important to recognise that this methodology has not been used before. It is helpful that there is a process of challenge about safety in the NHS because there always should be an ongoing dialogue about improving safety, but some trusts are, I think, justified in raising concerns about this methodology if they do not believe that it fairly reflects the standards at their trusts, especially if that portrayal gives rise to undue concern among the local community. The hon. Gentleman is right that there should be a process of interrogation of this methodology, but I am sure that that will happen in the coming days and weeks.

Is it not the case that patient satisfaction at these two hospitals and across the acute sector as a whole is very high, with 90 per cent. of patients judging their care to be “good to excellent”? Despite that, what more can be done to put patients at the centre of the NHS so that they receive good-quality treatment rather than being merely the passive recipients of care?

My hon. Friend makes a very important point. He is right that the latest findings on patient satisfaction in the NHS show that 93 per cent. of patients rate the care that they receive as excellent or good. I have asked myself precisely the same question as my hon. Friend and I referred in my statement to my intention to bring forward proposals soon about how we can link payment for hospitals more closely to patient satisfaction and quality, as indicated in Lord Darzi’s next stage review. I think that it is the way forward. It will enable us to focus the minds of those working in the management of hospitals on patients and, as my hon. Friend suggests, to make them the centre of concern. We will shortly present plans to increase the proportion of the tariff system that is accounted for by quality and safety.

Order. A number of Members are seeking to catch my eye. Unless we have much briefer questions—just one question each—and much briefer answers, a number of Members will be disappointed.

Blackpool, Wyre and Fylde Hospitals NHS Foundation Trust has worked very hard to reduce hospital infection rates at Blackpool Victoria hospital, and was deeply disappointed by the Dr. Foster analysis. What steps will the Secretary of State take to reconcile those different assessments of safety in hospitals so that the public can be reassured that their local hospital is as safe as the management say it is?

I have checked, and I know that the trust has been working hard across the board to improve safety standards. It has good progress to show for that work. I can tell the right hon. Gentleman and his constituents that the authoritative voice on these matters is the Care Quality Commission—although there will always be other voices challenging its assessment—and I refer him to the commission. There will, of course, be debate about the findings over the coming days.

Today, in the light of the inclusion of University Hospitals Coventry and Warwickshire NHS Trust in the 12 trusts that were analysed, I spoke to its medical director, Dr. Richard Kennedy. He had taken great exception to the findings of Dr. Foster, particularly those in respect of the standardised mortality ratio. The hospitals had provided Dr. Foster with amended data a month ago to conform with the new arrangements that were being sought, but the Dr. Foster organisation had chosen not to take any notice of those data or to include them in its findings. Will the Secretary of State take that up with the organisation, and ask why it happened?

When there have been such instances, I think it important for the facts to be established, and for clarification to be provided for trusts in that position if it is needed. It is not acceptable for concern to be raised at local level which is not justified. My hon. Friend has made his point very clearly, and I hope it will be followed up by both the trust and Dr. Foster. However, as I said to the hon. Member for North Norfolk (Norman Lamb), the hospital standardised mortality ratio is not in itself a verdict on hospitals. It is simply a trigger for investigation.

Basildon hospital enjoyed a first-class reputation when I was Member of Parliament for Basildon, and I am shocked and saddened by what has happened. If it is true that patients are to be transferred from Basildon to Southend, what assistance will the Secretary of State give Southend hospital to help it to cope with the situation?

I am sure that it was not just the hon. Gentleman’s departure that led to what has happened. Having served with him on the Health Committee, I know of the great interest that he takes in health matters. It is and will remain our policy for patients to have full choice across the national health service. We want to see the regular publication of higher-quality data, and that is at the heart of the new regulation regime that will be introduced next year. We have also introduced NHS Choices. If more patients choose to use Southend, that is their choice, and Southend will of course be paid accordingly by the necessary commissioners.

Will the Secretary of State accept that the obsession with structures, trusts and foundation trusts is entirely irrelevant to the level of care that we expect in our hospitals? Will he understand that the spending of a million pounds a throw on foundation trusts is simply a waste of money, and that the best work he can do is to put more money into front-line services, get rid of all this “architecture”—I think that that is what new Labour calls it—and concentrate on delivering a health service worthy of the name?

I hear what my hon. Friend says, but I am afraid that I disagree with him. If he speaks to chief executives and the senior leadership in any foundation trust in the country, he will find that the most helpful process they have been through is the process of applying for foundation trust status, as that gives them information about their organisations that they did not have before. The process has led to rising standards across the health service. While we cannot be complacent and we want to improve standards in foundation trusts where we need to do so, in many cases this reform has led hospital trusts to raise their game and improve what they do for local people.

The Secretary of State must appreciate that throughout the country there will still be considerable uncertainty as to the standards of care provided at hospitals. In his statement, on the one hand he implied that the CQC was authoritative, yet on the other hand he said that, where legitimate concerns had been identified, they would be followed up. Can he be more specific on how they will be followed up, and assure the House about the timetable for this, so we can get some greater certainty given the information that has been provided over the past few days?

I can indeed give the hon. Gentleman that assurance. That is the job of the CQC: its job is both to provide regular supervision of performance across the national health service, and where concerns are identified, to intervene and ensure that the necessary action is taken. It acted in respect of Basildon and Thurrock, and because it had not seen sufficient improvement, its concerns have now escalated and it is working in tandem with Monitor. That is how the process works. Where there are concerns about other trusts, it will follow them up with those trusts. I repeat what I said in my statement: I will update the House where any action has been taken.

As the Select Committee on Health has recently completed a report on patient safety that contains many helpful conclusions and recommendations, will the Secretary of State use his good offices to ensure that we have a full debate on patient safety?

I certainly agree that patient safety is of the highest importance and that it is crucial that this House devotes time to debating how to raise standards of patient safety. It is the one area where we can confidently say that there must never be complacency. There must be a continual process of interrogation of standards at all trusts, and just when a trust feels it is doing well enough, it should look again and improve its performance even further. I agree with the hon. Gentleman that we need to devote more time to debating patient safety on the Floor of the House.

I am grateful to Mr. Speaker for agreeing to my request for a statement on Colchester hospital. There is great concern and anxiety among the local population, and there is a need for urgent steps to be taken to give reassurance and to bolster the morale of staff throughout the Colchester Hospital University NHS Foundation Trust. That said, I attended the trust’s annual meeting, and what was said there does not reflect what we are hearing now. There appears to be a battle between the various quangos. Does the Secretary of State agree that we are witnessing the consequences of a box-ticking, target-setting agenda and that there is an urgent need for local democratic accountability?

I have to say that I do not agree with the hon. Gentleman. While I respect his views about his local trust, the regulator identified a number of performance and governance concerns, and it asked for a process of improvement at the trust. That did not follow within the time scale requested. I will defend the regulator in taking firm action, where standards need to rise. The hon. Gentleman will know that the foundation trust model allows patients to become members of a trust and to hold it to account. I encourage him and his constituents to use the voice that that reform gives them to hold their local trust to account and have their say in the delivery of local health care.

My right hon. Friend said earlier that NHS patient surveys always show very high satisfaction scores. Does he agree, however, that such surveys are not a good way to measure the variation in standards and safety in the national health service and that we need to make sure that we have the right mechanisms in place so that the best that is delivered in any hospital in the United Kingdom is achieved in every hospital in the United Kingdom?

I agree with the Chairman of the Health Committee that patient satisfaction is an important part of quality, but it is only a part of quality. It needs to be set against clinical safety standards and, of course, clinical effectiveness; it is crucial that the broadest possible view is taken of quality in the NHS, and that was the conclusion of Lord Darzi’s next stage review. I assure the Chairman of the Health Committee that as we develop plans for the NHS in the coming period, we will seek to embed the conclusions of that review in the payments structures of the NHS, so that there is a relentless focus on quality and safety in every NHS organisation.

Basildon hospital serves my constituents and it has some wonderful, caring staff, but since 2005, I have raised serious problems with the trust, which have not yet been addressed. On a specific point, may we empower patients and families by routinely providing them with personal antimicrobial products, so that they can actively participate in preventing the spread of health-care-associated infections in Basildon, as well as in all UK hospitals?

I hear what the hon. Gentleman says. I have not visited that hospital recently, but I am confident that, as happens in many other hospital trusts now, alcohol gels and other products will be freely available in the hospital environment for people to use to bear down on rates of infection. It is also important to say that rates of infection have decreased significantly right across the national health service, in respect of not only MRSA, but clostridium difficile. He is right to say, again, that there can be no complacency on this issue, and I am sure that the leadership at the trust will have heard his comments today.

May I remind the Secretary of State that new Labour was originally elected on the slogan “24 hours to save the NHS”? That now rings all too hollow to people who rely on Colchester general hospital for their health care. Will he reflect on that and explain why he is still having to make announcements of this nature, given that health expenditure has doubled since the Government were first elected?

The hon. Gentleman has a short memory about the state the national health service was in during the 1990s, when people routinely waited hours on end in accident and emergency departments up and down the country. I was looking last week at the patients charter, which, in the mid-’90s, set an 18-month maximum wait for treatment and a year’s maximum wait for heart bypass operations. Will he tell us how many people waiting for those heart bypasses never got to have the final operation, such was the state of the national health service in those days? Improvement has taken place in the NHS, but I say again that I do not over-claim for the NHS. When it needs to be better, I will say so and we will take the necessary action to make it happen.

Having met the management of Basildon hospital on Friday and toured a number of the wards, including the accident and emergency wards, I have been assured by the management and clinical staff that the hygiene recommendations of the CQC report have been implemented in full, with the help of a nursing taskforce. The key concern for my constituents is safety for patients in the hospital and for those about to go into it. How quickly can the Health Secretary report back to us on the progress and effectiveness of Monitor’s intervention for the sake of those patients and of the many people in Basildon hospital who are doing excellent work?

I welcome the close interest that the hon. Gentleman is showing in this issue. I want to give him the facts so that he can then make the necessary statements to local people in his constituency about the performance of the trust. I do not seek to put any spin on it; he can have those facts to show whether improvement is coming quickly enough.

As I said to the hon. Member for Brentwood and Ongar (Mr. Pickles) a moment ago, improvement has been made this year on the mortality ratio. I shall give the hon. Member for Billericay (Mr. Baron) those figures, but the judgment is that the progress needs to escalate. The trust now has the benefit of two senior professionals from one of the highest-performing trusts in the country, both on the medical and the nursing side. We expect them to start work immediately and a programme office based at the trust will be monitoring and overseeing progress. I shall give him updates as and when they are available, but I agree with him that improvements need to be immediate.

Basildon is one of seven trusts that have been shown to have a high mortality ratio not just for one year but for five years. One of those other trusts is Kettering, which serves my constituency. What will the Secretary of State do about the other six trusts identified by Dr. Foster?

May I say to the hon. Gentleman that this ratio was developed by Professor Brian Jarman, and we very much encourage its use? However, it is not of itself a verdict on a trust’s performance. It is simply a trigger that then gives cause for more investigation and inquiry. In many cases, trusts that have had a high mortality rate have been able to bring it down. There may be a number of reasons why a particular trust has a high standardised mortality ratio and the circumstances need to be investigated. I assure the hon. Gentleman that those trusts will be investigated. If we need to take further action, of course, we will.

It is not just about chief executives and managers. Every single surgeon, doctor, nurse and other professional has a professional duty of care to reduce risk. To that end, and to help them, can the Secretary of State tell me what progress has been made in introducing the checklist procedure for individual procedures that was pioneered in the Johns Hopkins hospital and that is shown to reduce morbidity and mortality rates? Is that being taken forward throughout the health service?

I assure the hon. Gentleman that it is being taken forward. If he does not mind, I will write to him with a detailed progress report on how adoption is proceeding through the national health service. I agree about the techniques pioneered by an institution as eminent as the Johns Hopkins university hospital in Baltimore. We have worked and looked internationally to use the best standards. The NHS has a reputation for learning and implementing quickly some of the best standards from around the world, but I will give the hon. Gentleman an update along the lines that he seeks.

Does the Secretary of State accept that it causes consternation and concern when the CQC rates hospitals as good and then Dr. Foster reveals such difficulties? It undermines confidence. In my constituency, in the Mayday hospital, there were issues to do with process that unfortunately led to constituents passing away, but then the CQC rated my hospital as good. Should I now feel that the CQC process for my hospital should be questioned?

I say again to the hon. Gentleman that the CQC is the authoritative voice on matters of safety and quality in the national health service. It was set up by Parliament to do that job. It takes a broader view of safety and quality in the NHS, looking across a much broader range of indicators than those used by Dr. Foster. However, I do not dismiss the work that has been done by Dr. Foster. In the case of a number of trusts that have been identified as a result of this work, there needs to be a further process of inquiry to establish whether the concerns are justified. The methodology used is new, and it needs to be questioned so that the hon. Gentleman can give clear advice to his constituents. I say again that the CQC is the leading and authoritative body set up by Parliament to do that job.