House of Commons
Wednesday 6 February 2013
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Minister for the Cabinet Office was asked—
Civil Society Organisations (Financial Support)
1. How much financial support the Government gave to civil society organisations in (a) 2009-10 and (b) 2012-13 to date. (141649)
It is estimated that the Government committed £13.9 billion to general charities in 2009-10. As the hon. Gentleman will know, data for 2012-13 are not yet available.
Thousands of people in every one of our constituencies depend on the services provided by voluntary bodies. The National Council for Voluntary Organisations estimates that funding for the sector will fall by £3.2 billion during the current Parliament, while the Charities Aid Foundation says that private giving to charities has fallen by 20%. The big society is shrinking. How are the Government going to give it the resources it needs to provide services for our constituents?
The Government are doing a great deal to support our charities. We are encouraging giving, volunteering and social investment, and we are trying to make it easier for charities to help us to deliver public services. There is less money around as a direct consequence of the actions, and the fiscal incontinence, of the Government whom the hon. Gentleman did not adorn. We all have a role and a responsibility to support our charities, but this Government are doing their bit.
That very same research by the Charities Aid Foundation clearly showed that 85% of respondents were concerned about the future financial viability of charitable giving. In view of the Minister’s response to my hon. Friend the Member for York Central (Hugh Bayley), may I ask why he does not share those concerns?
I do not need any lectures from Labour Members about the extent of the pressure that the charitable sector is under. At a time when resources are very constrained, the Treasury has introduced new tax incentives for giving, including the gift aid small donations scheme. Between them, those incentives will be worth hundreds of millions of pounds to the sector during the current Parliament. We are providing match funding for giving, and investing in new and innovative ways of encouraging it. The Government are showing a great deal of creativity in trying to connect people with the chance to give to and support charities in their communities.
Does my hon. Friend agree that the Kent Air Ambulance, the Pilgrims Hospice in Canterbury and homelessness charities such as Porchlight and Catching Lives demonstrate that there is a healthy sector in Kent? Does he also agree that the most successful elements of the charitable sector are those that raise the bulk of the funds themselves—with some help from the state—rather than the client organisations whose number increased under the last Government?
My hon. Friend, who is a tireless supporter of charities in his constituency, has raised an important point. It is worth reminding the House that 75% of charities receive no income at all from the state, and that 80% of the public funding that goes to charities goes to organisations with incomes of more than £1 million. We are actively trying to encourage more charities to live within their means and raise their own money by promoting the kind of giving that I mentioned earlier.
Voluntary and Community Sector
2. What recent progress he has made in increasing capacity in the voluntary and community sector. (141650)
The Government are doing a great deal in trying to increase the capacity and capability of the sector. One of the most important things that we have done is launch the world’s first social investment institution, Big Society Capital, which will have £600 million on its balance sheet. That will enable it to increase the social investment market and make it easier for charities and social enterprises to gain access to capital.
Will my hon. Friend congratulate the newly formed Wymering Manor Trust in my constituency on securing the manor as a community asset? In stark contrast to the smooth running of that transfer, the obstacles that the community have encountered in trying to buy out Portsmouth football club, and the culture that they have encountered in the world of football, have been dreadful. What more can be done to help fans to own and govern their local clubs, and to stop football being a big society-free zone?
I am delighted to congratulate the trust, not least because I understand that it is chaired by Conservatives. Let me also wish the supporters of Portsmouth football club well in their endeavours. The Government are trying to help communities to realise their dreams, and if there is anything that our Department or Big Society Capital can do to support that community, my hon. Friend must let me know.
I think that there is a different story. I visited the office of Fairplay in Derbyshire the other Friday and met the people there who look after, for instance, disabled teenagers. I have also visited various other voluntary organisations. Their story is that they are being cut left, right and centre, and are having a job making ends meet. When will the Government support the voluntary workers who are trying to rescue those people, and to help all kinds of individuals? This really has reached a chronic stage. Get something done!
We are doing a great deal. I totally accept what the hon. Gentleman says: there is a lot of pressure on charities in all our constituencies. We all know that there is less money around, but I would like to hear a little more honesty and recognition from the Opposition Benches as to why the cuts in public expenditure are necessary. They are the direct result of the fiscal incontinence of the hon. Gentleman’s party’s Government.
As the Minister reflects on the capacity of the voluntary sector, he will surely consider in particular the capacity of the Charity Commission—which has been cut by a third on his watch—to prevent charities such as Cup Trust from being used for huge levels of tax avoidance. Is the Minister convinced that the new head of the commission understands the seriousness of the situation, and is a cross-Government plan now in place to prevent such a repeat?
Yes. Under this Government, we have sent a very clear message to the Charity Commission that we expect it to hunker down on its core responsibility of regulating the sector and protecting its integrity, and, under the new chairman, we expect that to happen.
Tax Avoidance (Government Contracts)
3. What recent discussions he has had with the Chancellor of the Exchequer on ensuring that companies in receipt of Government contracts do not engage in tax avoidance schemes. (141652)
In the autumn statement, my right hon. Friend the Chancellor announced that the Cabinet Office and Her Majesty’s Revenue and Customs would examine how the procurement process can be used to deter tax avoidance and evasion. I expect an announcement to be made on this matter shortly with a view to new arrangements coming into effect from 1 April.
That is very welcome news, and I hope that friends of the Cabinet Office will be able to make sure that the Chancellor announces in the Budget that we will end once and for all the possibility of taxpayers’ money funding people to avoid paying their corporate taxes. That has to end at both national level and local government contract level.
I very much agree with my right hon. Friend. Our primary concern in public procurement is value for the taxpayer, but it is entirely legitimate to be concerned about ensuring that companies that are—rightly—profiting from Government contracts should be paying the proper amount of tax.
Is not the answer simply to put out a message to all companies that if they do not pay their taxes they will not get the contract?
I do not recall this ever being addressed by the previous Government. We have inherited very large numbers of extremely costly contracts where nobody has taken any interest in this subject at all.
Information Technology Management
4. What plans he has to achieve greater value for money from the Government’s management of information technology. (141653)
Days after the coalition Government came to office, we introduced strict controls on ICT spend that saved the taxpayer £316 million last year alone, a figure verified by the National Audit Office. We have opened up procurement to small and medium-sized enterprises, we are moving towards open standards and interoperability, and we are reopening some of the incredibly expensive and burdensome ICT contracts that we inherited from the previous Government, with a view to making significant further savings. There is much more that can be done, and much more that we will do.
I thank the Minister for that answer and welcome those actions. I also thank him for visiting Ark Continuity in my constituency, a company whose data centres make cloud computing possible. There are myriad data centres in local and national Government and in the wider public sector, and there are huge savings to be made. Will the Minister target this area in searching for ways to save the taxpayer money?
I enjoyed my visit with my hon. Friend to Ark Continuity. It was very illuminating. There is a huge amount we can do. Data centre capacity across Government is massively underused. A huge amount of overcapacity was left in place by the outgoing Government, who had no interest in these subjects at all. We are getting to grips with it, however. We need to do more, and we will do so; there is much more money we can save.
The fact is that the NAO did not verify the savings. According to the NAO, the Department overstated its claimed IT savings probably by tens of millions of pounds. The Minister has form on this: he predicted £20 billion of savings from his quango review, but the NAO showed he barely saved a tenth of that. Perhaps the Department should propose a new ministerial baccalaureate in adding up and taking away. Since the Minister cannot get his figures right, will he now at least agree to brush up on his maths?
The hon. Gentleman is talking total nonsense. We inherited a massive Budget deficit left by a Government who were fiscally incontinent and made no effort to deliver any efficiency savings whatsoever. Through our efficiency programme, we have already delivered £12 billion of savings and there is much more that can be done. The outgoing Government left the public finances and Whitehall efficiency in a shockingly sorry state.
5. What his policy is on the cyber-security partnership. (141657)
8. What his policy is on the cyber-security partnership. (141660)
On 25 January, the Foreign Secretary signed the World Economic Forum’s new set of principles on cyber-resilience. The UK was the first country to join that cyber-security partnership, alongside more than 70 companies and Government bodies across 15 sectors and 25 countries. That is an important step in demonstrating our leadership role on the international stage in combating cyber-threats.
I thank the Minister for that reply. Has she seen the recent report by Lancaster university, which is a centre of excellence in cyber-security and she is more than welcome to visit? The report highlighted the lack of investment by so many small businesses in even the simplest systems to protect their IT systems.
I very much welcome Lancaster university’s report, which I have seen. It does show the university’s place as an academic centre of excellence for cyber-security. That research gives us valuable insights into how business is responding. I understand that the Department for Business, Innovation and Skills will be supporting a further small and medium-sized enterprise conference with Lancaster university. The Government are bringing forward a cross-government cyber-security awareness campaign, which is aimed at SMEs. I ought to quote from the report, because I agree with its statement that small businesses should be able to
“embrace technology and prosper without exposing themselves to unwanted business risks.”
Cyber-security should be a growth area for UK industry. Will my hon. Friend tell the House what she is doing to help promote cyber-security for the UK industrial sector?
My hon. Friend is absolutely right about this. When we published the cyber-security strategy we made it clear that there are important opportunities for UK businesses. Our country has long-standing expertise in cyber-security, which makes us well placed to capitalise on the commercial opportunities on offer, both domestically and overseas. I can confirm to him that we have put in place measures to help promote UK products abroad, particularly through setting up a cyber-growth partnership.
If only the Minister’s warm words on international partnerships were matched by her Government’s actions. In October, the Home Secretary announced that the UK would opt out of cross-border co-operation on tackling crime—cybercrime is, of course, predominantly cross-border in nature. Will the Minister confirm that position? Specifically, will we be part of the new European cybercrime centre, or are her Government more obsessed with damaging Europe than strengthening our cyber-security?
First, I welcome the hon. Lady to her place in the Opposition Front-Bench team, although I hope that the Labour party has updated its website, as I do not believe its cyber-skills showed her in her correct place at the time she asked that question. Of course, I can offer my reassurance that the UK Government are doing all they can on tackling cybercrime, where there is much to be done. There is also much to be done in Europe.
In developing the cyber-security strategy, will the Minister consider forming a civilian cyber-security reserve, so that people working in the IT security sector can back-fill those positions that are very specialist and where the work perhaps cannot be carried out by the Ministry of Defence?
My hon. Friend makes correct points about the need to ensure that we have robust skills across both the public and private sectors in respect of cyber-security. There is much to do to build our country’s capability. He will know that the MOD is taking forward the development of a cyber-reserve, and he makes sensible points about a civilian version.
Contracts Finder Website
6. What assessment he has made of the effectiveness of the Contracts Finder website. (141658)
The Prime Minister launched Contracts Finder two years ago to make Government procurement opportunities more accessible for small and medium-sized enterprises. That is precisely what that site does.
I thank the Minister for her reply and her letter, which I received this morning in reply to my question to her and her colleagues last September about the number of contracts with Atos. We know that the Government have about £3 billion-worth of contracts with Atos and in her answer she referred me to the Contracts Finder website, but a significant number of contracts were not on that site. Now that she has provided those details, will she tell me why the Cabinet Office does not include contracts renewed since 1 January 2011 given that they are renewed and extended by her Department?
Of the contracts identified in response to the hon. Gentleman’s inquiries, only seven are required to be on Contracts Finder and each of them is there. We are publishing more contract opportunities and more contract information than ever before and we are seeing an increase in the amount of business going to SMEs. Contracts Finder was designed to help suppliers, particularly SMEs, to find contract opportunities, whereas the hon. Gentleman’s Government did nothing on that in 13 years.
The Minister has just referred to what happened three years ago. Has she had an opportunity to assess why small businesses were winning such a small share of Government procurement contracts when the Government came to power?
We are absolutely serious about opening up Government business to SMEs, and it is a shame that the previous Administration appeared not to be. We have made progress: we have posted information about the opportunities, as I said in response to the previous question; we have removed bureaucratic pre-qualification processes; we have given SMEs a voice at the top table; and we have made Government more accountable through the mystery shopper service. My hon. Friend knows that it is a shame that the previous Government did not do any of those things.
Civil Service Pensions
7. What estimate he has made of the potential savings to the Exchequer from the Government’s proposed reforms to civil service pensions. [R] (141659)
The Office for Budget Responsibility has estimated that this Government’s reforms of public service pensions will deliver more than £430 billion of savings over the next 50 years.
The Minister’s answer is good news for taxpayers, who include many of the 13 million people in this country without a pension at all, but it is also important that public sector workers receive a good pension. Will my right hon. Friend confirm that the revised structure is still a defined benefit one and that it is fairer to part-time workers, who are often women, and to lower-paid workers?
Public sector pensions, after the reforms are fully in place, will remain among the very best available. That is right and we are strongly in support of it, but the cost was out of control. It is now back under control.
What discussions are the Government having with trade unions representing civil servants to ensure the smoothest possible transition?
We have regular discussions at official and ministerial level with the civil service unions, which, for the most part, have adopted a constructive approach and want the change to be introduced as smoothly as possible. Those discussions continue.
National Citizen Service
9. What progress he has made on his plans for the National Citizen Service. (141661)
I am delighted to say that we think that almost three times more young people took part in NCS this year and I hope that the whole House will join me in congratulating those young people, who between them contributed some 750,000 hours of community service in their local areas. The number will grow again this year and teenagers can sign up at www.ncsyes.co.uk.
In an era when young people must take every advantage to give themselves a competitive edge, does my hon. Friend agree that the NCS furnishes graduates with the skills that will attract future employers?
Yes, I do. Young people and employers are telling us that. They recognise that the NCS helps young people develop the character skills, leadership, communication, teamwork and self-confidence that will help them succeed in the workplace. That is why we are so proud to support it.
Does the Minister agree that the NCS ought to go hand in hand with paying attention to first-class citizenship in our schools? Is he aware that citizenship in schools has been run down to almost nothing?
That is under review by the Department for Education, but I stress that NCS and programmes like it complement what is going on in schools to build the confidence of young people and change how they feel about what they achieve. They are enormously valuable.
10. I was delighted to attend Royds Hall school last year to see dozens of youngsters who had been inspired to sign up for the National Citizen Service. Can the Minister assure me that this fantastic scheme will be rolled out not only across my constituency, but across the rest of the country this year? (141662)
My hon. Friend is a tireless champion of NCS in his area, and I am delighted that we will shortly announce plans to expand the service this year. It will expand considerably in his constituency and other areas, and I encourage colleagues to tell parents and young people about it, and to direct young people to the website, ncsyes.co.uk.
T1. If he will make a statement on his departmental responsibilities. (141664)
My responsibilities as Minister for the Cabinet Office are for the public sector Efficiency and Reform Group for civil service issues; industrial relations strategy and the public sector; Government transparency; civil contingencies; civil society; and cyber-security.
The Government expect to increase debt by £212 billion more than they originally predicted, and our youth services are being cut to the bone. Study after study has shown, however, that the National Citizen Service, worthy as it is, has reached a tiny number of children. Is it not time that the Government either reformed the NCS to ensure that it provides better value for money or changed it altogether?
It ill behoves the hon. Gentleman to lecture this Government about debt and deficit, given the state of the public finances when his Government left office; there was reckless incontinence. The National Citizen Service, which we expect to expand, provides an incredibly valuable experience for growing numbers of young people, and I would be grateful for the hon. Gentleman’s support for it.
There is plenty of scope for an all-day debate, I think. I call Mr Peter Bone.
T2. To the coalition Government’s great credit, four months ago they started to tackle the scandal of civil servants being given paid time off to do trade union work. The TaxPayers Alliance has worked out that that costs £90 million a year. How many savings so far have the Government made on that £90 million? (141665)
One of the difficulties is that under the previous Government no one even monitored how much time was spent on trade union activities and duties. There is a statutory requirement to provide paid time off for trade union duties, but that was roundly abused. We now have in place a proper system of control and monitoring, and the cost will be cut right back.
T3. It is estimated that 71% of over-55s do not have access to the internet at home, so will the Minister explain exactly what support has been put in place to enable them to access Government services for which it is compulsory to apply online? (141666)
The hon. Lady will know that we have in place an assisted digital strategy, so that as we roll out our digital by default approach, which will provide services on a much more convenient basis for the citizen at much lower cost to the taxpayer, there will always be available a place where people can go so that the digital transaction can be carried out with the support of someone to help the citizen. [Interruption.]
Order. It would be helpful if the House listened to the questions and, indeed, to Ministers’ answers.
T7. Further to the question asked by my hon. Friend the Member for Epping Forest (Mrs Laing) about small and medium-sized enterprise procurement, does the Minister agree that it is not just a question of giving contracts to small firms but that it is essential that the public sector pays its bills on time? (141670)
I fully agree with my hon. Friend. He is absolutely right: not only are hundreds of contract opportunities being made available for SMEs, but the Government are a fair payment champion, recognised by external bodies for their behaviour, just as he said.
T4. Research published by the Charities Aid Foundation found that one in six charities feared having to close this year, putting at risk the services on which many vulnerable people rely. Will the Minister tell the House what action the Government are taking to prevent charities from going to the wall? (141667)
The Government are doing a great deal to encourage giving in this country. The Treasury has introduced new tax incentives for giving, and is working hard to make gift aid work better for the charity sector. The small donation scheme is looking at how gift aid can work with digital giving, and we are looking at how we can make payroll giving work much more effectively. Across a range of areas, the Treasury and the Cabinet Office are working hard to make sure that charities get the support that they need in these difficult times.
T9. What monitoring arrangements for taxpayer-funded trade union representatives did my right hon. Friend discover after the general election, and what is his policy on this matter? (141672)
Rather surprisingly, we found no arrangements whatever in place for monitoring the cost to the taxpayer of paid time off for trade union representatives. It had been allowed to spiral completely out of control under the previous Government and we are at long last bringing it under control.
T5. The Cabinet Office seems to have left out its responsibility for the Office for National Statistics when it listed its responsibilities. When it is clear that the country is facing a major problem of addictive gambling, why have the Government not carried out the gambling prevalence survey provided for in the Gambling Act 2005, so we do not know how much addictive gambling there is in the country? (141668)
As the hon. Gentleman ought to know, the Office for National Statistics is a non-ministerial Government department, which has statutory independence from Ministers.
T10. Will my right hon. Friend ensure that the Cabinet Office keeps a proper record of all the circumstances in which collective ministerial responsibility is set aside, so that we can have some transparency in relation to that process? (141673)
I will ensure that the records are meticulously kept.
The Prime Minister was asked—
Q1. If he will list his official engagements for Wednesday 6 February. (141634)
This morning I had meetings with ministerial colleagues and others, and in addition to my duties in this House, I shall have further such meetings later today.
I thank my right hon. Friend for that answer. I have given him notice of my question, which he may find particularly useful in the sense that it is fair and transparent and also very modern. In response to the many concerns expressed in yesterday’s debate, will he ensure that civil partnerships are open to heterosexual couples on an equal basis with homosexual couples?
I am grateful to my hon. Friend for giving me notice of his question. I will obviously listen carefully to what he says, but frankly I am a marriage man. I am a great supporter of marriage. I want to promote marriage, defend marriage, encourage marriage, and the great thing about last night’s vote is that two gay people who love each other will now be able to get married. That is an important advance. We should be promoting marriage, rather than looking at any other way of weakening it.
I want to ask the Prime Minister about the bedroom tax. Alison in Middlesbrough has 18-year-old twin sons who are both in the Army. The Prime Minister’s bedroom tax means that while her sons are away, she will be charged more for their bedrooms. She says:
“I resent the fact that both my sons are serving and protecting their country, and in return will not have a home to come home to when they are granted their much needed leave.”
What is the Prime Minister’s answer to Alison?
First of all, let me make it clear that this is not a tax; it is a benefit. I would make two points in respect of the specific case that the right hon. Gentleman raises. First, all the time Labour was in government, if somebody was in a private sector rented home and were in receipt of housing benefit, they did not get any benefit for empty rooms. That is important. So it is only fair that we treat people in social housing the same way. The second point is that if anyone is away from home, obviously their earnings are not counted, so the benefits of that person are likely to go up.
I look forward to the Prime Minister explaining to Alison why her paying £25 a week more from April is not a tax on her. As for his point about the private rented sector, I think he misunderstands the point of social housing. Part of its purpose is to protect the most vulnerable. According to the Government’s own figures, two thirds of the people hit are disabled. Let me tell the Prime Minister about an e-mail that I received last week, which says:
“My wife is disabled, has a degenerative condition and is cared for in bed.”
The gentleman goes on:
“Due to her illness and my own medical conditions I usually sleep in the spare bedroom.”
Why is it fair for him and hundreds of thousands of other disabled people like him to be hit by the bedroom tax?
As with every hon. Member, if the right hon. Gentleman wants me or the Department for Work and Pensions to look at a specific case, of course I will, but let me again make some detailed points to him. First of all, there is a £50 million fund to deal with difficult cases. But let me also make the basic argument of fairness that he seems to miss. If someone is in private rented housing and receives no housing benefit, they do not get money for an extra room, and if someone is in private housing and do get housing benefit, they do not get money for an extra room, so there is a basic argument of fairness. Why should we be doing more for people in social housing on housing benefit than for people in private housing on housing benefit? There is one additional point that, frankly, he has got to engage in. The housing benefit bill is now £23 billion a year. We know that he is against capping welfare and we know that he is against restricting welfare to below the rate of increase in wages. We know all the things he is against; we are beginning to wonder what on earth he is for.
The Prime Minister is spending more than £8 billion more than he planned on housing benefit because of his economic failure during this Parliament. I say to him that the whole point of social housing is to protect families, including the disabled. It does not sound like he is going to do anything for military families or the disabled, but let us talk about a group of people he is moved by. I have here a letter sent on his behalf by the Conservative party treasurer about the so-called mansion tax. It says:
“We promise that no homes tax will be introduced during the course of this parliament”.
It goes on:
“To keep the taxman out of your home…please help by donating today and supporting the ‘No Homes Tax’ campaign.”
Can the Prime Minister explain what it is about the plight of those people that he finds so much more compelling than that of those hit by the bedroom tax?
If the right hon. Gentleman is in favour of a mansion tax, why did he not introduce one in the 13 years he was in government? If he is so passionate about social housing, why did he not build any when he was in government? If he thinks we are spending too much on housing benefit—he has just said that the bill is going up—why does he oppose each and every attempt we make to get the welfare bill under control? The fact is that the public can see that we are on the side of people who work hard and want to do the right thing; all he can ever do is spend more money.
I say to the Prime Minister that he should not get so het up. After all, he has got nearly half his parliamentary party behind him.
The policy is not just unfair; it is not going to work either. In Hull, for example, 4,700 people are going to be hit by the bedroom tax, and there are just 73 council properties for them to move to. Can the Prime Minister explain how exactly that is going to work?
What this Government are doing is building more houses and controlling welfare bills. Frankly, the question is one that the right hon. Gentleman has to answer, too. If he opposes the welfare cap, if he opposes restrictions on increased welfare, if he opposes reform of disability benefits and if he opposes each and every welfare change we make, how on earth is he going to get control of public spending?
The clue is in the title: Prime Minister’s questions. He is supposed to try to answer the question.
The Prime Minister clearly does not understand his own policy, but I thought that he might say, “Move to the private rented sector,” because there are not enough council properties for people. This is where—[Interruption.] When he gets up I would like him to say what those people should do. The policy is supposed to save money, and that is where it is not going to work out. Another woman who wrote to me, Diane, says that
“my rent for my family home”—[Interruption.]
I do not know why Government Members are groaning—thousands of their constituents are going to be hit by this policy. Diane says that
“my rent for my family home is at present £65.68, whereas a one bedroom”
in the private sector “would cost over £100.” How can it possibly make sense to force people into a situation where they cost the state more, not less, by moving into the private rented sector?
What this Government are doing is building more homes. If the right hon. Gentleman supports that, will he now support our changes to the planning system and the new homes bonus? Will he support the things that will get more homes built and more people into jobs? We have 1 million extra people working in the private sector—that is what he has to engage in. He has absolutely no suggestions for how to get on top of welfare, to get our deficit down, to get our economy moving or, frankly, to do anything else.
So today we discover that the Prime Minister has not even got a clue about his own policy, which he is introducing in April. His answers today remind us of what his party and the country are saying about him. The only people he listens to are a small group of rich and powerful people at the top. That is why he has come up with a policy that is unworkable and unfair. He is a Prime Minister who is weak, incompetent and totally out of touch.
That is the totally pathetic, pre-scripted rubbish that we get used to every Wednesday. On the issue of who listens to whom, I have a very clear idea of who the right hon. Gentleman listens to, because we heard it in the LSE lecture by Len McCluskey, who said of the right hon. Gentleman:
“I met him and he asked me—‘Len, if you had three wishes, three things that you’d like us to do if we got back into power, what would you like them to be’”?
Len McCluskey’s answer was
“trade union freedoms, trade union freedoms, trade union freedoms.”
That is who the right hon. Gentleman wants to be the fairy godmother to.
At the time of the strategic defence and security review two and a half years ago, my right hon. Friend said:
“My own strong view is that this structure will require year-on-year real-terms growth in the defence budget in the years beyond 2015.”—[Official Report, 19 October 2010; Vol. 516, c. 799.]
Does that remain his view and has he heard any similar view expressed by the Leader of the Opposition?
It does remain my view, but I am afraid to say that, as far as I can see, I am the only party leader who believes that, in the years beyond this Parliament, we should increase defence spending in the way described by my right hon. Friend. The good news for all those who care about this issue is that it is agreed Government policy that the defence equipment programme needs real-terms increases up to after 2015. It is very important for us to be able to plan our exceptional equipment programme, which will give us some of the best-equipped armed forces anywhere in the world.
Q2. The Office for Budget Responsibility tells us that the bankers will pay £500 million less for the bankers tax than the Prime Minister promised last year, yet in April he will inflict a £500 million cut on the poorest through the second empty bedroom tax. How can he justify taking from the poor and giving to the rich? (141635)
I say to the hon. Gentleman—this is an important point—that we have introduced the bank levy. We think that that is a better answer than a one-off bonus tax. The bank levy will, of course, be paid every year, so it will raise considerably more than a one-off bonus tax. What my right hon. Friend the Chancellor has done when the bank levy has not come up to the figures that we require is increase the bank levy to make sure that they do.
I remind the House of my declared interests.
Tomorrow the Prime Minister will go to Brussels to argue, rightly, for a substantial reduction in common agricultural policy funding. Will he ensure that any reduction applies to farmers right across Europe, not just those in the UK? Will he also make sure that he does not fall into the same trap as his predecessor did last time around in 2005? When pressing for cuts, his predecessor ended up with a cut to the one part of the CAP that everyone thinks is worth while—the rural development programme and the environment.
My right hon. Friend speaks very knowledgeably about this matter. These will be extremely difficult negotiations. Obviously, our aim is the significant cut that I have spoken about. The point that he makes about agriculture is important, particularly in respect of the flexibility that we require to ensure that things such as the rural development programme continue to succeed.
Q3. We know that the Prime Minister has met lots of millionaires, but has he ever met anyone who will lose their home because of his bedroom tax? (141636)
I hold constituency surgeries and listen to all the sorts of cases that the Leader of the Opposition has brought out today. I have RAF Brize Norton in my constituency, and many forces families live there. What they say to me is that they want a Government who are on the side of people who work hard and do the right thing. They support the fact that we are capping welfare, getting on top of immigration and clearing up the mess left by the hon. Lady’s party.
Today is the United Nations international day of zero tolerance to female genital mutilation. Does the Prime Minister agree that Britain should be doing all it can to combat this dreadful abuse of the human rights of women and girls overseas and here in the UK?
I completely agree with my hon. Friend. She is right to raise this matter. The Government have made progress by chairing a forum to look right across the piece, including at what we do overseas through our aid programme to prevent the horrific practice of female genital mutilation and at what we do here to ensure that the Crown Prosecution Service and others are aware of the law and do everything they can to ensure that it is properly prosecuted.
Q4. Can the Prime Minister confirm that Atos has declared that Richard III is fit for work? (141637)
That is not a constituency case that has come my way. All I can say is that I hope it will engender a great historical understanding of these events among all our people and provide a great boost to the great city of Leicester.
This week’s announcement that the work of the Insolvency Service at Stockton is moving to Newcastle is the latest in a long series of similar announcements affecting the Tees valley, including the closure of Middlesbrough’s HMRC office by the previous Government. Will the Prime Minister look to bring extra work to the HMRC office in Stockton and to move another public sector agency to the Tees valley?
I will look very carefully at what my hon. Friend says. We want to ensure that public sector jobs are fairly distributed around the country, but we have to be frank and say that the real need is for a rebalancing in the economy, with growth in the private sector to make up for the decline in public sector jobs. Over the past two and a half years, the million extra private sector jobs have more than offset the decline in public sector employment. That is why unemployment is falling around the country.
Q5. The Prime Minister may not be aware of an opinion poll by the BBC in Northern Ireland showing that in all Six Counties there is now a clear majority in favour of the Union. People right across Northern Ireland recognise that when it comes to being part of this United Kingdom, we are better off together. (141638)
I sometimes try to avoid opinion polls, so I have not seen that one. It sounds as if it is one that will lift the spirits of almost everyone in this House, because we believe in a United Kingdom and in Northern Ireland being part of that United Kingdom.
Q6. Can the Prime Minister reassure this House that he still believes in increasing spending on the NHS and in ensuring that those funds go to the doctors and nurses at the front line of our service? (141639)
I can certainly give my hon. Friend that assurance. That is why we made a commitment to increase NHS spending in each year of this Parliament. We are on course to do that. Crucially, we want to ensure that the money goes to the front line. That is why the number of managers and administrators in our NHS is right down and the number of clinical staff right up.
Q7. Was it the double-dip recession, the slow-down in deficit reduction or the projected 60% increase in national debt over the next five years that led the Prime Minister to state that he had full confidence in his Chancellor? (141640)
I have confidence in the Chancellor because the deficit is down by 25%, there are a million extra private sector jobs and we are cleaning up the mess made by the Labour party.
In Dover, plans are moving forward for the building of a new hospital, after a decade in which local hospital services were decimated. May I, too, say that we need to increase investment in the NHS and focus on the front line?
This day, particularly when we are about to discuss what happened at Stafford hospital, is a day to talk about the importance of care in our health service, the importance of the front line and, above all, the importance of really looking at quality and listening to patients. Under this Government, of course resources have been constrained, for all the reasons we discuss across the Dispatch Box, week in, week out, but we made a conscious choice to put more money into the NHS and get that to the front line. That is why there are 5,900 more doctors and 19,000 fewer non-clinical staff. The money is going to the front line, but the focus needs to be on quality and the patient.
Q8. Does the Prime Minister share the concern of the Democratic Unionist party about suicide levels in our society? In the light of the debate later in this House, will he assure me and my party of the Government’s support to raise awareness of that issue and work with the devolved Administrations to tackle this scourge across the United Kingdom of Great Britain and Northern Ireland? (141641)
First, I commend the hon. Gentleman and the Democratic Unionists for tabling this motion and bringing forward the issue. We often do not talk enough or address the whole issue of suicide in our society and country, and it is absolutely right to do so. It is a shocking statistic that in Northern Ireland almost six times the number of people killed in road traffic accidents are lost to suicide. Raising awareness of the issue and ensuring a proper cross-Government strategy to help people deal with it is vital, and the DUP is right to raise it.
Q9. As a result of the financial mess the Labour Government left the country in—[Interruption.] (141643)
Order. The House must calm down. We have a lot of questions to get through and I intend to get through them. Let us have a bit of order for Mr John Leech.
Local councils have faced as tough a budget settlement as most other Departments. Does the Prime Minister share my dismay that Manchester city council is choosing to close libraries, leisure centres and the Mersey Valley Countryside Warden Service, while at the same time it was happy to spend hundreds of thousands of pounds on an Alicia Keys concert and leave £100 million in reserves sitting in the bank?
My hon. Friend makes an important point. Of course councils face difficult spending decisions, but in many cases the level of spending and grant they are still getting is equivalent to what they received under the last Government. Obviously, the economy has declined since then and we have to cut our cloth accordingly. Councils should be held accountable for the decisions that they make, and in some cases there can be little doubt that they are making high-profile cuts to try to make a point. They should not be damaging people’s livelihoods; they should be doing the best for their cities.
Will the Prime Minister confirm for the record that thanks to his cuts to the child care element of the working tax credit, families with children are losing up to £1,500 a year?
What has happened with child tax credit is that we increased it by £390 in this Government’s early Budgets. If we look at the benefits for a two parent, two child family, we see that that family will be getting more than £1,500 extra this year—that is £30 a week—compared with 2010. I am afraid the hon. Gentleman is wrong.
Q10. Will the Prime Minister pay tribute to the new President of Somalia, Hassan Sheikh Mohamud, whose Government have made remarkable progress over the past few months? Although there is still a long way to go, does the Prime Minister agree that the Somali peace process is a good example of Britain combining aid and development with energising the neighbouring states and the diplomatic community worldwide, and will he tell the House what role he envisages for the Somali diaspora here in the UK? (141644)
My hon. Friend makes a very important point, and to anyone wondering about the relevance of Somalia to us here in the UK, we must remember that that country has been the author of huge problems with terrorism, piracy and mass migration. Even to the most hardened sceptic of our aid budget I would say that Somalia is a really good case where engagement, aid and diplomacy can help that country to mend itself for the future. I hope that the diaspora will give full support to the new President, who is demonstrating a huge grip in his country on mending the problems that have bedevilled it for so long.
The Prime Minister’s career probably peaked when he was a Back-Bench member of the Home Affairs Committee in 2005. Will he revive his progressive courage of that time when he looks at the report from the all-party parliamentary group on drug misuse on the awful problems of new drugs that are on the market but not controlled in any way?
I am grateful for the hon. Gentleman’s view of my career trajectory. I will not ask him about his—perhaps we can agree about it afterwards. I learned some important lessons from the Home Affairs Committee report I worked on, including on the priority we give in tackling drugs to education and treatment. Those are the two key arms of what needs to be done. However, I do not believe we should be legalising drugs that are currently illegal. On current legal highs and problems relating to substances such as khat, which was mentioned in a previous question, we need to look carefully at the evidence on what will work best.
Q11. In Solihull, more than 80,000 people have benefited from our policy of raising the threshold at which people start to pay tax. This morning, the Institute for Fiscal Studies confirmed that that policy is right, and that those who have the broadest shoulders are bearing the greatest burden of tax. In the light of that, will the Government commit to raising the threshold at which people pay tax to £10,000 in the Budget? (141645)
I thank the hon. Lady for her question—she is absolutely right about raising the threshold before which people start to pay tax. It means that the tax bill for someone on the minimum wage working full time has been cut by one half. That is a huge change to help people who work hard and want to do the right thing. This Government are rewarding them. She mentions the IFS green budget, which came out this morning. I have not had that much time to study it, but one thing stood out. On fairness, it states:
“The whole set of tax and benefit changes introduced between the start of 2010 and 2015–16 will hit the richest households hardest.”
This Government are fair, and we are helping the hardest working.
Q12. The Leader of the Opposition asked the Prime Minister a very simple question to which he gave no adequate reply, so I will ask it again. What is the difference between a bedroom tax on the disabled and a mansion tax on millionaires? (141646)
I do not accept that the bedroom tax is a tax—it is about benefit. The fact is that, as a country, we are spending £23 billion on housing benefit. We must have a debate in this country about getting on top of housing benefit—the previous Government said that. Indeed, it featured in the Labour manifesto on which all Labour Members were elected. Since they have moved to the Opposition Benches, they have given up all pretence of responsibility.
Can the Prime Minister reconcile his recent comments on the need to accelerate major infrastructure projects with the Government’s decision to postpone forming a policy on airports until after the next general election? Will he reconsider and bring that review forward?
I listen very carefully to my hon. Friend, but Sir Howard Davies says in his review that this is a complicated issue that merits proper examination, which will take time. We need, as a country, to make major decisions on airports and airport capacity. We should aim as far as possible to try to make those decisions on a cross-party basis. I hope the Howard Davies report helps that to happen.
Q13. Last night’s vote on same-sex marriage is widely regarded as a historic vote. Does the Prime Minister agree that the vote is a tribute to the people down the decades who have worked—in all parties and no party, behind the scenes and in public—for such equality? Does he also agree that the vote proves that the arc of history bends slowly, but bends towards justice? (141647)
I agree very much with the hon. Lady. Last night’s vote will be seen not just as one that ensured a proper element of equality, but one that helps us to build a stronger and fairer society. Many of the speeches made last night were very moving and emotional. I pay tribute to all those people who have made the case—some have made it for many years—that they want their love to count the same way as a man and woman’s love for each other counts. That is what we have opened in this country, and why I am proud this Government brought it forward.
For years, young people in Goole and Brigg have had some of the lowest per pupil school funding in the country. This is now becoming critical for counties such as the East Riding of Yorkshire. Will the Prime Minister look closely not just at the 40 authorities, but specifically at the low level of per pupil funding that the East Riding of Yorkshire receives?
I will look closely at what my hon. Friend has said, but I will make a couple of points. Within the education budget we have prioritised per pupil funding, so there has not been a reduction in per pupil funding. It is very important that schools can see forward to future years to the sorts of budgets that they will have, given the roll of children coming to their school. The second thing we have done, through the academy programme, is to encourage the devolution of more of the schools budget to schools directly, and I still think there is more we can achieve on that agenda.
Q14. The Prime Minister said that he would give the public a strong voice in the NHS, and his former Health Secretary said that he would put patients at the centre of the NHS. Why then was a motion to strengthen patient and public involvement in the new patient watchdog rejected by the Government in the other place last night? (141648)
We do want to see patients have a stronger voice in the NHS, and we are about to debate, at some length in terms of the Mid Staffordshire inquiry, how that is done. One of the most important ways of doing that will be to make sure that the NHS Commissioning Board mandate has at its heart quality nursing, quality care and the voice of patients. We also need to look at how HealthWatch will work to ensure that it is truly independent. We have to understand that some of the ways we have tried to empower patients in the past—the report we are about to discuss goes into this in some detail—and give them a better voice, always with good intentions from Governments on both sides of the House, just have not worked, and we have to listen to Francis when he says that.
With more women in work than ever before, with more men in work than ever before, and with more jobs created in the private sector, does the Prime Minister agree that not only is the Chancellor’s plan A working, but that the economy is beginning to turn the corner?
I am grateful to my hon. Friend. We should listen very carefully to the Governor of the Bank of England. He has said that growth is slower than we would like, but that the economy is moving in the right direction and that rebalancing is taking place. The things that need to be fixed in our economy, in terms of bank lending and the housing supply, are being fixed, and that is what the Government are determined to do.
One of my constituents has learned that when the bedroom tax is introduced she will have £24 a week to live on. She is so anxious about how she will manage she is receiving cognitive behavioural therapy. Her anxiety is totally understandable. Does the Prime Minister agree that those who should be receiving cognitive behavioural therapy are the ones—namely his Ministers—who think that she could live on £24 a week?
The Opposition have to address the fact that for 13 years in government they were perfectly content to have a housing benefit system for people in private sector housing that had no extra benefit for empty rooms. I cannot understand why they cannot see that it is unfair to have one rule for people who have the benefit of social housing with lower rents and another rule for people in private sector accommodation. Week after week, Labour MPs and the Labour leader come here opposing this benefit change, that benefit change and everything we do to deal with the mess they left to fill in the deficit they left us. Until they learn to take some responsibility for the mess they left, no one will ever listen to them.
Mid Staffordshire NHS Foundation Trust (Inquiry)
Today, Robert Francis has published the report of the public inquiry into the Mid Staffordshire NHS Foundation Trust.
Mr Speaker, I have a deep affection for our national health service. I will never forget all the things that doctors and nurses have done for my family in times of pain and difficulty. I love our NHS. I think it is a fantastic institution and a great organisation that says a huge amount about our country and who we are, and I always want to think the best about it. I have huge admiration for the doctors, nurses and other health workers who dedicate their lives to caring for our loved ones. Nevertheless, we do them and the whole reputation of our NHS a grave disservice if we fail to speak out when things go wrong.
What happened at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 was not just wrong; it was truly dreadful. Hundreds of people suffered from the most appalling neglect and mistreatment. There were patients so desperate for water that they were drinking from dirty flower vases. Many were given the wrong medication, treated roughly or left to wet themselves and then lie in urine for days, and relatives were ignored or even reproached when they pointed out even the most basic things that could have saved their loved ones from horrific pain or even death. We can only begin to imagine the suffering endured by those whose trust in our health system was betrayed at their most vulnerable moment. That is why it is right to make this statement today.
An investigation by the Healthcare Commission in 2009, a first independent inquiry by Robert Francis in February 2010 and, long before that, the testimony of bereaved relatives, such as Julie Bailey, and the Cure the NHS campaign all laid bare the most despicable catalogue of clinical and management failures at the trust. Even after those reports, however, important questions remained unanswered. How were these appalling events allowed to happen and to continue for so long? Why were so many bereaved families and whistleblowers who spoke out ignored for so long? Could something like this ever happen again? These are basic questions about wider failures in the system, not just at the hospital, but right across the NHS, including its regulators and the Department of Health.
That is why the families called for this public inquiry and why the Government granted one. I am sure the whole House will want to join me in expressing our thanks to Robert Francis and his entire team for their work over the past three years. The inquiry finds that the appalling suffering at the Mid Staffordshire hospital was primarily caused by a “serious failure” on the part of the trust board, which failed to listen to patients and staff and failed to tackle what Robert Francis calls
“an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities.”
The inquiry finds, however, that the failure went far wider. The primary care trust assumed others were taking responsibility and so made little attempt to collect proper information on the quality of care. The strategic health authority was
“far too remote from the patients it was there to serve, and it failed to be sufficiently sensitive to signs that patients might be at risk.”
Regulators, including Monitor and the then Healthcare Commission, failed to protect patients from substandard care. Too many doctors “kept their heads down” instead of speaking out when things were wrong. The Royal College of Nursing was
“ineffective both as a professional representative organisation and as a trade union”
and the Department of Health was too remote from the reality of the services that it oversees.
The way Robert Francis chronicles the evidence of systemic failure means that we cannot say with confidence that failings of care are limited to one hospital, but let us also be clear about what the report does not say. Francis does not blame any specific policy, he does not blame the last Secretary of State for Health and he says that we should not seek scapegoats.
Looking beyond the specific failures that Francis catalogues so clearly, we can identify in the report three fundamental problems with the culture of our NHS. The first is a focus on finance and figures at the expense of patient care—he says that explicitly—underpinned by a preoccupation with a narrow set of top-down targets pursued, in the case of Mid Staffordshire, to the exclusion of patient safety or listening to what patients, relatives, and indeed many staff members, were saying. Secondly, there was an attitude that patient care was always someone else’s problem. In short, no one was accountable. Thirdly, he talks about defensiveness and complacency. He finds that, instead of facing up to and acting on data that should have implied cause for concern, all too often there is a culture of only explaining the positives rather than any critical analysis. Put simply, managers were suppressing inconvenient facts in favour of looking for comfort in positive information. This is one of the most disturbing findings. It is bad enough that terrible things happened at that hospital, but what the inquiry is telling us is that there was a manifest failure to act on the data that were available, not just at the hospital but more widely. As Francis says:
“In the end, the truth was uncovered…mainly because of the persistent complaints made by a…determined group of patients and those close to them.”
The anger of the families is completely understandable. Every hon. Member in this House would be angry—they would be furious—if their mother, father or loved ones were treated in this way, and rightly so.
The previous Government commissioned the first report from Robert Francis. When he saw that report, the former Secretary of State—now the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham)—was right to apologise for what went wrong. This public inquiry not only repeats earlier findings, but shows wider systemic failings, so I would like to go further as Prime Minister and apologise to the families of all those who have suffered for the way the system allowed this horrific abuse to go unchecked and unchallenged for so long. On behalf of the Government—and, indeed, our country—I am truly sorry.
Since the problems at the Mid Staffordshire hospital first came to light, a number of important steps have been taken. The previous Government set up the National Quality Board and the quality accounts system. This Government have put compassion ahead of process-driven bureaucratic targets and put quality of care on a par with quality of treatment. We have set this out explicitly in the mandate to the NHS Commissioning Board, together with a new vision for compassionate nursing. We have introduced a tough new programme for tracking and eliminating falls, pressure sores and hospital infections, and we have demanded nursing rounds, every hour, in every ward of every hospital, but it is clear that we need to do more. We will study every one of the 290 recommendations in today’s report and we will respond in detail next month, but the recommendations include three core areas—patient care, accountability and defeating complacency—on which I believe we should make more immediate progress. Let me say a word about each.
First, let me address how we put patient care ahead of finances. Today, when a hospital fails financially, its chair can be dismissed and the board can be suspended, but failures in care rarely carry such consequences. That is not right, so we will create a single failure regime, where the suspension of the board can be triggered by failures in care as well as failures in finance, and we will put the voice of patients and staff at the heart of the way in which hospitals go about their work. In Mid Staffordshire, as far back as 2006, there was a staff survey in which only around a quarter of staff said they would actually want one of their own relatives to use the hospital that they worked in. Over the following two years, bereaved relatives and campaigners produced case after dreadful case and campaign after chilling campaign, but these voices and these horrific cases were ignored. Indeed, the hospital was upgraded to foundation trust status during this period. We need the words of patients and front-line staff to ring through the boardrooms of our hospitals and, frankly, right beyond, to the regulators and the Department of Health itself.
So from this year, every patient, every carer and every member of staff will be given the opportunity to say whether they would recommend treatment in their hospital to their friends or family. This will be published and the board will be held to account for its response. Put simply, where a significant proportion of patients or staff raise serious concerns about what is happening in a hospital, immediate inspection will result and suspension of the hospital board may well follow. Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards—that a little bit of these things is somehow okay. It is not okay; they are unacceptable—full stop, end of story. That is what zero harm—the jargon for this—means. I have therefore asked Don Berwick, who has advised President Obama on this issue, to make zero harm a reality in our NHS.
Francis makes other recommendations. Today it is possible to give hands-on care in a hospital with no training at all. Francis says this is wrong and I agree. There are some simple but quite profound things that need to happen in our NHS and in our hospitals. Nurses should be hired and promoted on the basis of having compassion as a vocation, not just academic qualifications. We need a style of leadership from senior nurses that means that poor practice is not tolerated and is driven off the wards. Another issue is whether pay should be linked to quality of care rather than just to time served at a hospital. I favour this approach.
Secondly, on accountability and transparency, the first Francis report set out very clearly what happened within Stafford hospital, and it should have led to those responsible being brought to book by the board, by the regulators, by the professional bodies and by the courts. But that did not happen. Most people will want to know why on earth not. We expect hospitals to take disciplinary action against staff who abuse their patients. We expect the professional bodies—the professional regulators—to strike off doctors and nurses who seriously breach their professional codes. And, yes, we expect the justice system to prosecute those suspected of criminal acts, whether they take place in a hospital or anywhere else. But in Stafford those expectations were badly let down. The system failed, and that is one of the main reasons we badly needed this public inquiry.
Now that the recommendations about systemic failure are public, the regulatory bodies in particular are going to have some difficult questions to answer. The Nursing and Midwifery Council and the General Medical Council need to explain why, so far, no one has been struck off. The Secretary of State for Health has today invited them to explain what steps they will take to strengthen their systems of accountability in the light of this report, and we are going to ask the Law Commission to advise on sweeping away the Nursing and Midwifery Council’s outdated and inflexible decision-making processes.
The Health and Safety Executive also needs to explain its decisions not to prosecute in specific cases. Indeed, Robert Francis makes a strong argument that the Health and Safety Executive is too distant from hospitals and not the right organisation to be focusing on health care and criminal prosecutions in such cases. So we will look closely at his recommendation to transfer the right to conduct criminal prosecutions away from the HSE to the Care Quality Commission.
Thirdly, we must purge the culture of complacency that is undermining the quality of care in our country. This requires a clear view about what is acceptable and what is not. In our schools, we have a clear system of deciding whether a school has the right culture and whether it is succeeding or failing. It is a system based on the judgment of independent experts who walk the corridors of the school and analyse more than just the statistics. The public therefore know which schools near them are outstanding and which are failing. They have a right to know exactly the same about our hospitals.
We need a hospital inspections regime that does not just look at numerical targets but examines the quality of care and makes an open, public and explicit judgment. So I have asked the Care Quality Commission to create a new post, a chief inspector of hospitals to take personal responsibility for that task. I want the new inspections regime to start this autumn, and we will look at the law to ensure that the inspector’s judgment is about whether a hospital is clean, safe and caring, rather than just an exercise in bureaucratic box-ticking. In the meantime, I have asked the NHS medical director, Professor Sir Bruce Keogh, to conduct an immediate investigation into the care at hospitals with the highest mortality rates and to check that urgent remedial action is being taken.
Complacency in the system has meant that, all too often, patient complaints have been ignored. So I am today asking the right hon. Member for Cynon Valley (Ann Clwyd) and the chief executive of South Tees Hospitals NHS Foundation Trust, Tricia Hart, specifically to advise on how NHS hospitals can handle complaints better in the future.
I have talked today about some of the systemic failures, but at the heart of any system are the people who work in it and the values they hold. It is worth quoting in full what Francis says, early in his report:
“Healthcare is not an activity short of systems intended to maintain and improve standards, regulate the conduct of staff, and report and scrutinise performance. Continuous efforts have been made to refine and improve the way these work. Yet none of them, from local groups to the national regulators, from local councillors to the Secretary of State, appreciated the scale of the deficiencies at Stafford and, therefore, over a period of years did anything effective to stop them.”
What makes our national health service special is the simple principle that the moment you are injured or fall ill, or the moment something happens to someone you love, you know that whoever you are, wherever you are from, whatever is wrong, and however much you have got in the bank, there is a place you can go where people will look after you and do everything they can to make things right again. The shocking truth is that that precious principle of British life was broken in Mid Staffordshire.
We would not be here today without the tireless campaigning of the families who suffered so terribly, and I am sure that the whole House will join me in paying tribute to their incredible courage and determination over those long and painful years. When I met Julie Bailey and the families again on Monday, she said to me that she wanted the legacy of their loved ones to be an NHS safe for everyone. That is the legacy that together we must secure, and I commend this statement to the House.
I thank the Prime Minister for his statement and for the tone in which he made it. The NHS represents the best values of this country, and what happened at Stafford was an appalling betrayal of those values. We all think that when our own loved ones—our mother or father, grandmother or grandfather—go into hospital, we are placing them in the trust of the NHS and we expect hospitals to be places of utmost compassion and the highest standards of care. At Stafford, patients became victims and their relatives who pleaded for assistance were ignored or even made to feel intimidated.
Let me join the Prime Minister in paying tribute to all those former patients, relatives and staff who came forward to speak out, including those who gave evidence to this and to previous inquiries. Let me also thank Robert Francis for his work on this and on the previous inquiry.
Let me also say, as was reflected in the Prime Minister’s remarks, that what happened at Stafford was not typical of the NHS. Day in, day out, the vast majority of those who go to work in our NHS deliver great care to patients up and down the country. They are as horrified as all of us by what happened in Stafford.
The previous Government were right to apologise on behalf of the Government and the NHS to the patients and families that suffered so badly at Stafford hospital. I reaffirm that today. We on the Labour side are truly sorry for what happened. What happened has no place in any NHS hospital. We must ensure that it does not and cannot happen again.
As the Prime Minister makes clear, today’s report says that the primary responsibility for what happened lay with the board of the hospital, but there are wider lessons that politicians on all sides must learn, including a lesson for all parties about the dangers of frequent reorganisations of the NHS, which Francis mentions.
The Prime Minister says it will take some time to digest the report in full, so let me ask some specific questions. First, on the patient voice, effective regulation is essential, but the reality is that regulators cannot be everywhere spotting every problem. Patients, their families and staff are everywhere in our NHS, so we must ensure that they are properly heard.
The challenge is to change the culture of the NHS and to support rather than shut out people who complain. The NHS constitution offers protections for whistleblowers, and we support moves to strengthen that. The Francis report, however, also highlights criticisms and concerns about both previous and current arrangements for patient bodies. Does the Prime Minister agree—from something he said earlier, I think he does—that whatever bodies we choose to represent patients, they need to be independent and have the powers to be an effective voice and challenge to the system.
Secondly, on staffing, the basic requirements of any NHS hospital are that there are sufficient staff to look after patients and that they act with compassion. In too many cases at Stafford, that just did not happen. Compassion should always be at the heart of nursing, and it needs to be at the heart of nurse training, so we support the moves that the Prime Minister announced.
As Robert Francis has said previously—I quote from the first report—in explaining what went wrong:
“the overwhelmingly prevalent factors were a lack of staff, both in terms of absolute numbers and appropriate skills”.
Does the Prime Minister accept the report’s point that we need to consider benchmarks on staff numbers and skills throughout our NHS?
Thirdly, on regulation, the problems at Stafford should have been picked up much earlier. Monitor and the Healthcare Commission should have worked together much more closely. We will look at the Prime Minister’s proposals around the chief inspector of nursing care, but does he support the move to a single regulator, which is in the Francis report? On health care assistants—the Prime Minister mentioned them—who do such important work in our hospital wards and communities, does he agree that we need training and registration for them to improve standards and safety?
Fourthly, on foundation trust status, the enthusiasm for foundation trusts has been shared on both sides of this House, and the journey to foundation trust status has clearly been a beneficial process for many trusts. In the case of Stafford, however, it clearly was not. For the future, has the Prime Minister made any reassessment of the current timetable for other trusts to achieve foundation status and of whether more flexibility is needed?
Fifthly, on waiting time targets, today’s report clearly states that
“it is not suggested that properly designed targets, appropriately monitored, cannot provide considerable benefit to patients”.
In other words, targets have their place, but they must be kept in their place. Does the Prime Minister accept that, as the Francis analysis suggests, the problem at Stafford was how the A and E target was managed by that hospital, and that many hospitals up and down the country have delivered excellent care while meeting the A and E target? Neither he nor I want to go back to the days when people were left waiting 12 hours on trolleys and 18 months for an operation.
Finally, let me turn to the issue of integration. I believe that there is a bigger overarching issue here, which applies not just in Stafford, but elsewhere in our NHS. It is something that my right hon. Friend the shadow Health Secretary has talked about recently. The ageing society is bringing a whole new set of demands on the NHS. A group of elderly and infirm patients require not just physical treatment for their immediate illness, but need much greater care and attention for their basic needs. As the Francis report says, we must address this new challenge that the NHS faces to make sure we avoid a repeat of what happened at Stafford.
Does the Prime Minister agree that in every hospital we need to put in place the right support for the whole of a person’s needs, including those of the elderly population? Does he further agree that that means breaking down the barriers that still exist in much of the country between health care provided by the NHS and social care provided by local authorities?
We cannot turn the clock back and undo the damage that happened at Stafford, but we owe it to those who suffered, to the people of Stafford and to the country as a whole to work together to act on this report and to prevent a scandal like this from happening elsewhere. We in the Opposition will play our part in making that happen.
I thank the right hon. Gentleman for his remarks and for the tone in which he made them. I apologise for not getting my response to the report to him a little earlier this morning. That was a technical mistake rather than anything more sinister. The right hon. Gentleman is right to thank the relatives and to thank Robert Francis for his work. Let me try to answer the right hon. Gentleman’s questions.
On the issue of reorganisations, Francis says:
“The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require root and branch reorganisation—the system has had many of those—but it requires changes which can largely be implemented within the system that has now been created by the new reforms.”
I hope we can agree that the best thing to do now is to learn the lessons and put in place what needs to be done.
The right hon. Gentleman is absolutely right to raise the issue of listening to patients. As he said, we have got to make sure that whatever organisation we have—we have established HealthWatch—is independent, credible and has power. It is interesting to note what Francis finds on page 46:
“It is now quite clear that what replaced”
community health councils, and there were
“two attempts at reorganisation in 10 years, failed to produce an improved voice for patients and the public, but achieved the opposite.”
We need to learn the lessons and try to make sure that HealthWatch becomes everything we all want it to be.
As for supporting complaints, what Francis and the right hon. Gentleman said is that when there are complaints, they have got to be given a bigger voice and be taken seriously. Here, Members of Parliament have a role to play. Somewhere, buried in the report, there is a passage that is mildly critical of MPs. Like others in the community, we love our local hospitals and we always want to stand up for them, but we have to be careful to look at the results in our local hospitals and work out whether we should not sometimes give voice to some of the concerns rather than go along with a culture that says everything is all right all of the time—sometimes it is not.
On the issue of staff numbers and benchmarks, we think it important that there should be some benchmarks. We believe that because of the funding commitment we have made, there is no excuse for understaffing or for staff shortages, but that obviously requires good management.
On having a single regulator, the right hon. Gentleman made a lot of points about Monitor and the Care Quality Commission and whether there was confusion between them. When he talks of strengthening the CQC and giving it greater powers, that is in principle, as I said in my statement, the right direction to go in.
The right hon. Gentleman asked about trusts, and both sides of the House have supported the idea of foundation trusts, making sure hospitals are more accountable, more responsible and able to take more decisions. The problem is not with creating foundation trusts, but arises if the move to create them means that other things that matter more than trust status—such as patient care—are pushed to one side. We must all learn the lesson and ensure that for the next round of trust creation, they must not be rushed and they must happen only when they are ready and on the basis that patient care comes first.
The point about targets is important. I believe that there is a place for targets in our NHS, but I think that under the last Government they became too tight and too obsessive. I also think that the last Government recognised that themselves, and started to change the approach.
The public have a right to know that waiting times in A and E will not be too long and that treatments will be carried out quickly, so there is an importance in targets. I think that what Francis is saying is that it was not the targets that were to blame, but a culture in the hospital—and perhaps in other hospitals, although he does not inquire into that—in which targets and their achievement were placed ahead of patient care. Again, the two should not be alternatives.
What the right hon. Gentleman said about the ageing population and the challenge facing our NHS was absolutely right. A key part of our dementia challenge is raising the standard of, in particular, the way in which we treat elderly people in our hospitals. I also agree with the right hon. Gentleman that we need to break down the barrier between health and social care.
I hope that the report will provide not an opportunity to try to find scapegoats or to fire up some phony political debate, but a moment when everyone in the House can agree. We all love our national health service, and this afternoon’s discussion shows that we have the same ideas about patient care, about quality, about bringing health and social care together, and about ensuring that a good, rational system has patients at its heart. I hope that this can be a moment when the country comes together over our NHS, rather than seeking divisions.
Today is a day on which, first of all, we think of those who suffered in Stafford and of their loved ones. I thank the Prime Minister and the Leader of the Opposition for the tone that they have adopted. I also pay tribute to Julie Bailey and Cure the NHS, to Robert Francis, to my hon. Friend the Member for Stone (Mr Cash), to my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), to the Secretary of State and to the Prime Minister for the way in which they have championed the cause of this inquiry.
I know how passionate the Prime Minister is about the NHS and the work that goes on day in, day out, and I share that passion. Does he agree that the most important thing that we can do for the patients and their loved ones who have suffered is implement the recommendations that we are able to implement as quickly as possible, so that they can result in an NHS that is safe for all and is known for the highest standards of compassion and care?
I am sure that my hon. Friend, who has spoken up about this issue for many years, spoke for everyone in Stafford and throughout the country when he said that we should put the victims up front and centre. They are the people we should be holding in our thoughts today because of how they have suffered.
I agree with what my hon. Friend said about implementing the recommendations. There are 290 of them, so we must examine them carefully and see how we can best implement them, and the Department of Health will lead that work. Let me make two additional points. First, the recommendations are not simply for the Government or the Department; they are for every hospital, every nurse and every doctor to consider. I think it very important for that to happen. Secondly, as I tried to make clear in my statement, for all the changes in the system and all the corrections of regulatory failure that may be made, a system is only as good as the people who work in it. I think that at the heart of what Francis is saying is a cry from the heart that this is about quality, vocation and compassion, and that those are the values that we need to put back at the heart of the NHS.
I welcome the fact that there has been a public inquiry, and I welcome the Prime Minister’s statement.
What has happened in Mid Staffordshire affects the whole of Staffordshire. In view of the emphasis that is now to be placed on compassion as well as on targets, and in view of what the Prime Minister has said about the role of social care, may I ask whether he will arrange for local Members of Parliament to have some form of oversight in Staffordshire so that the collaboration that will be needed to introduce this culture change can be put into practice on the ground, particularly in the light of closures that involve social care homes as well?
I think it very important for the voice of local Members of Parliament to be listened to. The Secretary of State has said that he will ensure that Staffordshire Members of Parliament, and Members of Parliament representing Stoke-on-Trent, can advise him on the issue. Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says “Oppose the local change”. I know that that is what the hon. Lady was saying, but I think that this is a moment when we may be able to ensure that our political culture is more in line with what is required in our health culture.
Many of my constituents died unnecessarily at Stafford hospital between 2005 and 2009. Given Monitor’s continuing review of the future of Mid Staffordshire’s foundation trust, I remain astonished that it was given foundation trust status in 2009, when all these problems were going on.
Does the Prime Minister agree that the biggest lesson that can be learned is that when front-line professionals who love and care about the NHS are genuinely concerned about standards of care, we should have a system that allows them to speak out without fear of exposure or victimisation?
My hon. Friend is absolutely right to speak up for the victims from Cannock and their families, whom he represents properly in the House. He is right to say that we must listen to the voices of victims and patients, and he is also right to talk about the reform of regulatory bodies, although, as I said earlier, we should be careful about thinking that just reforming regulatory bodies will be enough.
My hon. Friend specifically mentioned the importance of whistleblowers. It should not be necessary to rely on whistleblowing to deal with problems of quality, but sometimes it will be. We have taken measures to fund a helpline to support them, to embed rights in their employment contracts, and to issue new guidance in partnership with trade unions and employers. So we are taking the issue of whistleblowers seriously.
As Health Secretary, I changed the law to provide protection for whistleblowing and to make hospital boards responsible for the quality of care. I am sure the Prime Minister accepts my disappointment that those changes were clearly not sufficient to avoid the things that happened in Mid Staffordshire.
May I issue a warning? I greatly welcome the proposal to make openness, transparency and candour a legal requirement, but if we are to do that in a litigation-obsessed society, it will need to be matched by the introduction of a system of no-fault compensation. Otherwise, it is possible that in some hospitals the doctors will be outnumbered by ambulance-chasing lawyers.
I will consider carefully what the right hon. Gentleman has said about no-fault compensation. The cost of litigation in the NHS is clearly a rapidly rising part of the budget, and that is of concern.
The right hon. Gentleman’s point about the laws that he changed is important. What I think we have observed in Governments of all parties is the belief that changing the law to make it clear that quality is important as well as cost, and that patient care matters, does not necessarily lead to a change in the culture.
That returns me to the point made by my hon. Friend the Member for Cannock Chase (Mr Burley). The report makes it clear that when the issue of foundation trust status arose, those who were judging it did so on the basis of a whole series of metrics that were mainly financial, and on the basis of targets, rather than looking behind those for the quality. It is a culture change that will ensure that, when a hospital board meets, the first things that it considers are clinical standards, quality and patient care. That is the first stuff: that is actually what the organisation is meant to deliver. The board can think about the finances, the targets and all the rest of it afterwards. It is that culture change that needs to take place.
On behalf of my constituents and the victims and relatives who have been so grievously traumatised by these tragic events and the lack of patient care, I congratulate my right hon. Friend on realistically listening, as Leader of the Opposition, to my repeated calls in Parliament for a real public inquiry, which he established under the Inquiries Act 2005, I also congratulate him on his statement, and on his praise for the inquiry itself and for Cure the NHS—in particular, Julie Bailey, my constituents Debra Hazeldine and Ken Lownds, and all the others who have campaigned so effectively and with such passion for patient care.
I thank my hon. Friend for what he has said. He did call repeatedly for a public inquiry, and he was right to make such a call. That is reflected in the report, and he can read it today. What was required was not an investigation of the failure in the hospital, but an investigation of the wider systemic failure. For instance, why was this not brought to light more quickly? What was the role of the regulator? What was the role of the Nursing and Midwifery Council? All that is laid out in the report.
However, I think that there was another very profound reason for holding a public inquiry, although I know that it will not satisfy some of the victims. They feel incredibly strongly, and rightly strongly. These terrible things happened to their loved ones, but where is the criminal prosecution? Where are the people who have been struck off? There has not been proper accountability, and there is not proper accountability in our system. A public inquiry can look to the future and say, “Here’s what needs to change,” so if this ever happens again—I hope to God it does not—there will be much better accountability than the people of Stafford have had.
The tragic events at Stafford are having a continuing impact on both management and care at the University hospital of North Staffordshire. A and E closures at Stafford have caused major strains, for example, and our new hospital was already struggling as a result of bed closures ordered a few years ago by Sir David Nicholson’s travelling troubleshooter, Antony Sumara. For reasons of patient safety, our hospital’s chief executive last year rightly reopened many of those beds to cope with the added A and E pressures. That has only added to the financial pressures, however. When rather distant bureaucrats at the Department of Health and the regional health authority play their part in responding to those pressures, will the Prime Minister ensure that they do so with sympathy and local understanding and put patient safety and care at the heart of the response?
I agree with the hon. Gentleman that when those above and beyond a hospital are making decisions on questions such as whether the hospital should become a foundation trust, they must look very closely at quality of patient care, not simply financial and other metrics. That is at the heart of what Francis is saying. The CQC believes that the hospital is currently providing an adequate standard of care. Only last week it carried out an unannounced inspection and it was content with what it found. Recent reports have been disturbing, however, and there is important work still to do in this hospital as in others, because “adequate” is never good enough; they have to strive to be better, and I know that that is what is going on.
Whatever the abject clinical and management failings, this was at heart a truly disgraceful failure of leadership at all levels. Indeed, too many inadequate and failing managers in leadership positions are repeatedly recycled through the NHS. Accordingly, will the Prime Minister consider establishing a national health service staff college to which senior managers may go, and ensure that no senior manager may take command of a hospital trust or any higher post unless he is a graduate of such a college?
I thank my right hon. Friend for his remarks. When he has a chance to look at the report in more detail, I think he will be pleased to see that Robert Francis suggests something along those lines: he suggests some form of leadership college. We think that has merit and will look at it carefully. I am nervous about committing instantly to creating more NHS organisations and institutions as there are a lot already, but the point my right hon. Friend makes is a good one.
The other point my right hon. Friend makes is vitally important in terms of the accountability issue: all too often when something has gone wrong in one of our hospitals, managers or overseers are recycled and reappear, as if by magic, in another part of the NHS. We need all those responsible for accountability—the CQC, Monitor, the Nursing and Midwifery Council, the General Medical Council—to take a clearer view about whether someone is up to the job or not.
I thank the Prime Minister for his statement and the manner in which he made it. Does he agree that our biggest challenge is to make quality of care the central organising principle of the NHS? That was recognised by Lord Ara Darzi, although I am not sure whether we were particularly successful at pursuing it. We can all say that that is the challenge, but addressing it creates a series of problems, including—as I was saying to my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson)—the problem of productivity. If nurses and GPs and other doctors are to spend more time with patients and focus on care, there will be ramifications for other ways in which we measure how the health service is working. Does the Prime Minister therefore agree that the challenge that Ara Darzi sets is about how to make care truly the central organising principle of the NHS?
The right hon. Gentleman speaks with great knowledge of, and affection for, the NHS, and I, too, am a fan of Ara Darzi and think he has a huge amount to offer. He had a big hand in giving priority to quality at the end of the last Government’s term. Francis is saying that there needs to be a culture change in respect of quality, but we must also look at what we are currently measuring. If hospital managers are measured on financial metrics and target metrics, rather than on quality of care—that is what we see flowing through the report—all the words we say and laws we pass on quality of care will not have sufficient impact. We need to look at that.
I welcome the report and the Prime Minister’s response, including on the hospital inspectorate proposal. Will he ensure that the Government’s full response includes giving special consideration to trying to change the culture of calling for the lawyers, which is what often currently happens when there are complaints? Instead, everybody should know in advance who is responsible for the ward, who is responsible for the clinical care and who is responsible for the management, and that they will be held to account. We must also ensure that the best practice in clinical care—which we often see in our wards—is used to judge what works and we are very tough on those who have failed.
My right hon. Friend makes two points. First, I agree that we need clear lines of accountability so we can see who is responsible for standards of care on the ward and in the hospital, and they must be held to account for that. Secondly, I have a lot of sympathy with the point that sometimes people making a compliant are not seeking financial redress, and I think all constituency MPs would agree with that, too. They just want to be taken seriously. They want to be listened to; they want an acknowledgement. They will not go off and hire lawyers. They want an acknowledgement that their elderly relative was not treated properly, and they want it soon. I hope this report launches a debate in the NHS about how we can deliver that.
There remains real trauma and anguish in Stoke-on-Trent about the abuse, poor treatment and unnecessary deaths of relatives and friends in Stafford hospital. I welcome the focus on delivering a culture of care in the management of hospitals and on the accountability of boards, and I also welcome the questioning of nursing and medical bodies about the absence of accountability. I have two questions, however. What elements of the new NHS reforms make it less likely that a Mid Staffs will occur again, and are we absolutely sure that HealthWatch will be fit for purpose in April? On the north Staffordshire health care economy, the University hospital of North Staffordshire is taking a lot of slack from Mid Staffordshire. Can we ensure that the Department of Health supports North Staffordshire in addressing any problems?
Let me go directly to the important question about the reforms, the status quo once they are in place and how that will help deliver what Francis talks about. As I said in answer to the Leader of the Opposition, Francis says he is content this can be delivered:
“it requires changes which can largely be implemented within the system that has now been created by the new reforms.”
I hope the reforms will help in a number of ways. I hope HealthWatch can be created as a robust independent organisation that is taken seriously by those in the health service and more widely. I hope that having clinical leadership of the clinical commissioning groups, with local GPs and others in charge, will mean they will reach further into their hospital and perhaps ask better questions than the primary care trust put. As I said at Prime Minister’s questions, I also hope that the Department of Health sets a mandate for the national Commissioning Board and that we put quality and care for patients at the heart of it. While I accept that we need some process targets because things such as waits in A and E matter, I hope that the move towards judging outcomes rather than processes will reinforce the importance of quality, because if we do not get quality care, we will not get quality outcomes.
The Prime Minister will be aware that since the closure of the A and E at Stafford, Queen’s hospital in Burton has been dealing with some of the patients that would have gone to Mid Staffs. Will he join me in thanking all the staff at Queen’s and the other hospitals across Staffordshire who have worked so hard to try to deal with the consequences of the Mid Staffs fallout? Given that he understands the genuine concern that is felt in my constituency and across Staffordshire about health care, will he assure my constituents that never again will ticking boxes be put ahead of caring and compassion in the NHS?
I can certainly give my hon. Friend that guarantee. The whole tenor of this report is that quality patient care must come before anything else, including targets, no matter how important they can sometimes be. I join him in praising those in his own local hospital who have been working hard and delivering accident and emergency services. If anyone wants to understand just how badly the target chasing and obsession got at Stafford hospital, they can see on page 108 in volume I some chilling evidence that staff just felt they could not complain about quality because they were being chased so hard on the targets that everything else was put to one side.
The Prime Minister has said that the concerns of patients’ families were ignored, but in fact they and representatives were lied to. One consequence of what happened at Mid Staffordshire is that, despite nobody suggesting that there is a widespread problem throughout the NHS, people have a real fear: whenever there is a case of poor care in one of our hospitals, people immediately jump to conclusions and ask, “Is this a wider problem?” I look forward to hearing the Prime Minister’s comments in a moment, but I hope that this report will go some way to alleviating people’s very real fear that when they see one of their loved ones treated in a way that falls way below or slightly below the standard they were expecting, they can have the confidence to know that it is not Mid Staffs all over again.
I listened carefully to what the hon. Gentleman said, and I am sure he is right; I do not think we are looking at other problems across our NHS of a Stafford-style scale, where this went on for year after year and potentially hundreds of people lost their lives prematurely. However, we do know that there are problems in parts of our NHS and problems in individual hospitals. One of the things we have to learn from this report is that when that happens we must not say that everything is fine and we must not have a culture of complacency. Instead, let us have a proper way of dealing with the problems. That is the big change that needs to come out of this.
Many of my constituents both use and depend on Stafford hospital. Will my right hon. Friend assure them that future nurse training will all be focused on care and compassion, and not on an obsession with targets?
The Care Quality Commission has said that Stafford hospital is providing adequate care. There was a recent inspection to check up on it, and obviously more work needs to be done as it recovers from this. We need to be absolutely clear that nurses not only provide amazing care, but are also well trained and can carry out some quite complicated medical procedures, and they are proud of that. They are often—dare I say—better sometimes than the junior doctor at putting in the cannula or whatever. We should praise that and we should want to have professional nurses. The key thing that needs to change as we employ and train nurses is that we make sure that at the heart of their reason for wanting to do the job is not just access to the qualifications and the career, but a real belief in compassion and caring, and that it is a vocation.
Apart from addressing the training of nurses, we need nurses who do not mind wiping people’s bottoms or holding the sick bowl under somebody’s face, but there are not enough of those any more. I am glad that the Prime Minister talked about compassion and care. I have received more than 1,000 letters and e-mails since I first spoke out from people who echo some of the points he has made today and which we all know about as constituency MPs. There must be an opportunity for whistleblowers to act without fear of reprisal. There must be freedom for people to make complaints, to speak out and to say when they see that something is going wrong. I only wish that I had spoken out and shouted, instead of thinking that I was leaving somebody in the hands of professionals, which, I am afraid, did not extend to the care and compassion we would all expect somebody to be treated with in hospital.
I just wish to pay a quick tribute to the campaigners, as the Prime Minister has done. I pay particular tribute to Julie Bailey, whom I have also met. I have met dozens of those people, and I think we would all applaud their tenacity in speaking out and sticking to their guns. I look forward to helping to make the system better because, as the Prime Minister has said, we all love the NHS, but we know that there are systemic faults in it at the moment.
I thank the right hon. Lady for what she says, and I am delighted that she is going to be helping us with this piece of work to really set out how complaints should be properly handled. I think she speaks for everyone when she says not only that she loves the NHS, but that when we see the best level of care handed out to loved ones, it is one of the most inspiring things in the world, and that is why it is so disturbing and so hurtful when we see poor standards of care and people let down. We have to get a balance right in this debate: we must continually and rightly praise nurses, health care assistants and doctors for the care and compassion they provide—for what they do every day—but we must marry that with a determination that where there is bad practice we should join them in pointing it out. There has been a culture of complacency that we have all been part of—MPs are to blame here, too—for too long.
I note that the Prime Minister shares the shock and incredulity of the people of Staffordshire, the county where I was born and which I represent, that such terrible things can happen in one of their local hospitals. I am pleased that he says he will make it easier for whistleblowers and for patients to put on record their experience of care. Will he say a little more about the speed with which he expects those data to be put in the public domain, so that patients, the public and hospital managers can make quick and informed decisions about what is going on in their hospitals?
I thank my hon. Friend for that. Like others, Staffordshire MPs have spoken with great passion about their care for their local health service and what it can provide.
On the timing, Robert Francis says that he wants all parts of the NHS to respond to him on what they are going to do right across the NHS, and that should be done over the next year. The Department of Health will be looking in the coming months at all the recommendations and responding. Specifically on the inspections, which are so important, as I said in my statement we are going to look at these changes to the CQC, but even before that Bruce Keogh is going to run this set of inspections into hospitals that have high rates of mortality and make sure that they are being dealt with properly.
It is quite clear that the Public Interest Disclosure Act 1998, which was supposed to encourage and protect whistleblowing, has failed in this case when faced with the culture of the NHS. On the lessons that could be learned, the Health Committee published a report in 2009 on patient safety and recommended that the Government should look at how whistleblowing was handled around the world, particularly in New Zealand. There, it is handled by an independent person, who carries out the inquiry, often anonymously from the complainant, and gets a far better reaction from institutions than we do here in the United Kingdom.
The right hon. Gentleman makes a powerful point about whistleblowers and how we handle them, and I am sure that Health Ministers will listen to that. I just make the point that supporting whistleblowers is one thing, but we also have to respond to what is being said. There were whistleblowers in the case of the Stafford hospital, but the problem was that the response to the complaints, the campaigns and the whistleblowing was completely inadequate.
I do not necessarily share the enthusiasm of others for hospitals to gain foundation trust status, particularly those serving less than half a million people. I note with interest that the chief executive of Heatherwood and Wexham Park Hospitals NHS Foundation Trust, who oversaw the foundation trust status being secured a few years ago, has now retired with a healthy pension and so on. That trust is now £80 million in debt and unsustainable. I also note with interest that the chief executive in this case cited the old chestnut of stress-related illness in order to avoid contributing to the report. When are we going to draw up contracts so that people get sacked for poor performance, be it financial or clinical? As far as I am concerned, the same should apply to hospital managers as applied to bankers.
My hon. Friend speaks with considerable knowledge of the NHS, and he is absolutely right to say that it is depressing to look down the list of those responsible for the Stafford hospital at the time and see what has happened. It reads “Left on compromise agreement”, “Left on compromise agreement”, “Stepped down” and “Now working somewhere else”. As I said, the accountability mechanisms in the NHS are not good enough, which is why this report is so important. I now want to see all the organisations—the trusts, the CQC, the Department of Health, the General Medical Council and so on—answering the question: why is bad practice not punished properly? That is one of the key things that has to come out of this report. That is not everything that those campaigners from Stafford want to hear; they want more accountability from the people involved in this problem. I can understand absolutely why they want that, but I think that what we can get out of the Francis report is a sense that there are going to be proper rules to deal with failure in the future.
Order. These are extremely serious matters being treated with great knowledge and sensitivity. I want to accommodate everybody who is interested in the subject, but we would now benefit from slightly shorter questions and I need therefore look no further than to a specialist in the genre, Gisela Stuart.
Further to the Prime Minister’s previous answer, what precise steps will he take to force trusts not to accept early resignations or moving on? What will he do to stop that recycling, which has been going on for ever?
There are two answers. The first relates to the contracts that are signed in the first place; every trust board needs to read the report and think about how it will put in place those contracts. The second is to make sure that when there are failures, proper action is taken. That is what needs to happen.
Will the Prime Minister ensure that the chief inspector of hospitals has access to all the information that he or she needs from the General Medical Council and all the other bodies? Does he agree that wards for the elderly in particular need regular inspections by nurses?
My hon. Friend makes an important point. My view—we can debate this over the coming weeks—is that quite a lot of transparent information is available in the NHS, but it is not properly acted on. What we need from the chief inspector of hospitals is a sense that, as in schools, you consider the data, walk the wards, look at the quality of care with a professional team and then reach a judgment. People do not necessarily need all the data; they need a judgment. They need to know whether the hospital is okay, whether it is clean and whether it cares for people. That is what is required.
The report is clear that at the heart of this dreadful series of deaths was a failure to pursue the concerns and complaints of patients and their families vigorously and properly. The Prime Minister mentioned the Nursing and Midwifery Council. Does he know that unlike other professional regulators that body does not have the power to review, reopen or revise disciplinary decisions, even when there is fresh information or when it thinks it has got it wrong? Will he fix that flaw without delay?
The right hon. Gentleman makes an important point. That is why we asked the Law Commission, as I said in my statement, to consider sweeping away the council’s current rules and putting proper rules in their place.
Is there not always a role for concerned community oversight? Will my right hon. Friend confirm that members of local health and wellbeing boards, members of HealthWatch and constituency members of Parliament should always be welcome visitors at their local hospitals?
My hon. Friend makes an important point. Members of scrutiny councils or any of the other bodies he mentioned should be able to walk the wards and have a look around, and that is vital. It is worth looking in detail at the report’s findings on scrutiny committees and the rest of it. It has some pretty good recommendations on how they need on occasion to sharpen their act.
The executive summary of the Francis report states on page 45:
“There was an unacceptable delay in addressing the issue of shortage of skilled nursing staff.”
The CQC tells us that 17 hospitals are operating with dangerously low levels of nursing staff, resulting in poor care. Does the Prime Minister agree that it is now time to do something about levels of nursing and those ratios rather than leaving it to hospital boards or individual trust boards to decide them?
What the hon. Lady says about the importance of having clear benchmarks for what is acceptable is right. Over the past few years, the ratio of nurses to acute beds has improved. The paragraph to which she refers is interesting, as it states:
“There can be little doubt that the reason for the slow progress”
in dealing with the shortage of nurses
“and the slowness of the Board to inject the necessary funds…was the priority given to ensuring that the Trust books were in order for the”
foundation trust application. This is absolutely what Francis is saying: finances and targets were put ahead of patient care, so that is the big change that needs to take place.
I have here the executive summary to the report; it alone is 100 pages long. The Prime Minister has acted swiftly in appointing an inspector of hospitals and exacting the help of a number of specialists in the industry. Does he agree that we also need political will and scrutiny, and will he ensure that all the findings can have full cross-party parliamentary scrutiny to drive the changes and ensure that this will never happen again?
I hope that we can have not just scrutiny but a proper debate. I am sure that the Leader of the House—who played a key role in ensuring that the inquiry happened, for which I pay tribute to him—will be able to make time for a debate at some stage to consider the report in detail. It is absolutely enormous, and I have the three volumes of it here, but helpfully volume 2 goes through the key areas—the strategic health authorities, the primary care trust and what the regulator did—so that we can see an outline of the concerns about the lack of focus on patient care that flow through it so clearly.
I compliment the Prime Minister on his statement and my right hon. Friend the Leader of the Opposition on his response. I have not had a chance to go through the recommendations, but the Prime Minister mentioned the failings at trust board level. Will he agree to consider a recommendation from the health service section of my union, Unite, that a national intelligence unit linked to a national telephone hotline, which could be answerable to the chief inspector of hospitals under the CQC, could analyse the information coming in and identify where the problems were so that the chief inspector could take corrective action?
I will consider carefully what the hon. Gentleman says and I am sure that colleagues in the Department of Health will, too. My sense is that there is quite a lot of transparent information about mortality and morbidity rates, through Dr Foster and the rest of it. In too many cases, there has been an unwillingness to act and to act with enough clarity. We should focus on that, too.
Of the three main failings highlighted in the Francis report, may I point out particularly to my right hon. Friend the third—that of the defensive culture in the NHS? Historically, clinical negligence cases continually highlight the fact that it is the recognition by hospitals that something has gone wrong that often blocks the issue being addressed. My right hon. Friend was absolutely correct to say that often families are not looking for financial remuneration but for a clear apology. May I impress on him and the Secretary of State my request that any future inspection regime should put that at the heart and the centre of any inspection?
My hon. Friend is right. That was why I mentioned in my statement the importance of trying to have a transparent and frank inspection system, such as that in schools, because that challenges complacency. If a report is received that says that a school is not up to standard, the community knows and the teachers know. Yes, it can be depressing for a while as it is sorted out, but it is much better than leaving problems to fester.
I thank the Prime Minister for his statement and I am sure that he will agree that care cannot and should not be measured as a chargeable unit. May I draw his attention to a report by the Health Committee, published in June 2011, on complaints and litigation? How will he ensure that it is not just the front-line overstretched staff who must listen to patient voices but, more important, the senior management?
The hon. Lady is right. What strikes me as I meet hospital managers is when they say that at their board meetings they take patient care, clinical standards and safety standards first. That is the right thing to do because if a hospital is not safe, if it is not clean and if it is not caring for people, it is not doing its job—never mind whether it is meeting its targets or whether the numbers add up. That is absolutely at the heart of this question and that is one of the things that needs to change.
Crucially, the report identified the problem of inadequate staffing levels, which often lies at the heart of care problems in the NHS. However, only recommendation 163 of the 290 recommendations mentions any action on that. Will the Prime Minister ensure that the Government bring forward stronger guidance to benchmark registered nurse to patient ratios on hospital wards to address that fundamental basic problem?
I have said that I think there is a role for benchmarking and considering those issues, but we would be missing something if we thought that this was all about systems and figures. Quality of patient care, vocation and compassion must be at the heart of all this.
The Prime Minister mentioned that Members of Parliament should be involved and I think the report mentioned it, too. When I first came to this place more than 20 years ago, I was stuck on a Committee called the parliamentary Select Committee for the ombudsman, who has the power of a High Court judge. We used to look at health service cases very regularly and bring the board members and chief executive in front of us. Why was the ombudsman not involved in this case?
The hon. Gentleman makes a good point about how things have changed, and perhaps we should look at that. As Members of Parliament take an interest in this, let me read what the report says on page 47. It is not good news, I am afraid:
“Local MPs received feedback and concerns about the Trust. However, these were largely just passed on to others without follow up or analysis of their cumulative implications. MPs are accountable to their electorate, but they are not necessarily experts in healthcare and are certainly not regulators. They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare.”
I join others in pleading guilty: sometimes we can be too defensive of our local institutions, and sometimes we need to dig deeper into particular issues and complaints. It is important, as I have said, that everyone considers the report, and that is one for all of us.
As part of the Government’s response to the report, may I urge the Prime Minister to look at the use of compromise agreements and gagging clauses when NHS managers leave the organisation?
I certainly think Health Ministers should look at what my hon. Friend says. One of the outcomes should be a discussion about what sort of contracts are appropriate for board members, both for their service in the NHS and if anything goes wrong.
I would like to speak from my recent experience of being a chief exec of a children’s hospice. The CQC is a very good organisation, but in my own area, each officer is responsible for up to 40 organisations, so the attention they can give each one is not that much. I was pleased that the leaders of both parties have said that they would support more funding for the CQC and support strengthening it.
All nurses have to register with the Nursing and Midwifery Council, which is a disciplinary body, but it can take up to 18 months for the disciplinary process to go through. The NMC is the investigator, the judge and the jury. I am supportive of the Royal College of Nursing, which genuinely seems to be trying to help and support its nursing staff to give better care. It is prioritising care but, again, it is under-resourced.
To try to end on a positive, I urge the Prime Minister to look at examples of good practice. Rotherham Doncaster and South Humber NHS Foundation Trust has an exemplary service of putting patients first. It has 12,000 members who select a governing body, and the board is responsible to that governing body. It seems that one of the problems with Mid Staffordshire was that the public were not right at the heart of the organisation.
I am sure the hon. Lady is right, and I agree that there are many examples of excellent practice, not only in health care and patient care but in responding to complaints and involving the local public; I see that across the country.
I have just read out what the report says about MPs, and this is what it says about the Royal College of Nursing:
“At Stafford, the RCN was ineffective both as a professional representative organisation and as a trade union. Little was done to uphold professional standards among nursing staff or to address concerns and problems being faced by its members.”
That is uncomfortable for the RCN to read, just as it is uncomfortable for us to read what it says about MPs, but it must be acted on. Likewise, the Care Quality Commission is improving, but more work needs to be done. Francis is pretty excoriating, and says on page 931 of volume 2:
“The CQC has an unhealthy culture, in which senior managers are more concerned about public image than delivery, which is hostile to internal and external criticism, and in which staff feel under pressure and unsupported.”
There is real work to be done in all these organisations to get this right.
“Systems so perfect that no one will need to be good.” That is T. S. Eliot, but it is a slightly pithier version of many recommendations in the Francis report. Does the Prime Minister agree that it is a tragedy that it has taken a tragedy to produce the report? My dad, as president of the British Orthopaedic Association in 2006, gave a lecture entitled “A New Professionalism” to reflect the alarm of clinicians at the changing culture in the 2000s, with a burgeoning management system and management priorities, tick boxes and targets taking precedence over clinical priorities. The Prime Minister has acknowledged that systems cannot replace professionalism, but will he listen to current professionals, who say that professionalism, which is what keeps the NHS afloat, is being eroded by things such as the working time directive?
My hon. Friend packed a lot into her question, but I agree that we need greater clinical leadership across the system. When we look at Francis carefully, what he is saying is that things such as targets and better financial management were important. We cannot have an organisation such as a hospital, which is a multi-million-pound organisation with thousands of staff, without proper management, proper finances and the rest of it. We have to make sure that there is proper clinical leadership, and that the focus is on care and quality, as her father said.
Does the Prime Minister agree that what happened at Mid Staffs was not just a failure of regulation but a failure of basic humanity? Apart from a few whistleblowers, ward sisters, nurses, doctors and consultants must have seen what was happening on those wards day after day, and did nothing, although their professional