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Care Quality Commission (Morecambe Bay Hospitals)

Volume 564: debated on Wednesday 19 June 2013

I wish to make a statement about today’s independent report on the Care Quality Commission’s regulatory oversight of University Hospitals of Morecambe Bay NHS Foundation Trust. What happened at Morecambe Bay is, above all, a terrible personal tragedy for all of the families involved, and before saying anything else, I want to apologise on behalf of the Government and the NHS for all the appalling suffering that those families have endured. In that context, I know that the whole House will wish to extend our condolences to every single one of them.

Joshua Titcombe’s tragic death was one of 12 serious untoward incidents, including five in the maternity department. His family and others have had to work tirelessly to expose the truth, and I pay tribute to them for that, but the fact is that they should not have had to go to such lengths. As we saw in the case of Mid Staffs, a culture in the NHS had been allowed to develop in which defensiveness and secrecy were put ahead of patient safety and care. Today I want to explain to the House what the Government are doing to root out that culture and ensure that that kind of cover-up never happens again.

The independent report was commissioned by the new chief executive of the CQC, and the members of the new team that is running it have made it clear that there was a completely unacceptable attempt to cover up the deficiencies in their organisation. The report lists what went wrong over a period of many years. There were unclear regulatory processes, a report was commissioned and then withheld, key information was not shared, and there were communication problems throughout the organisation. Most of the facts are not in dispute, and all of them are unacceptable. They have compounded the grief of the Titcombe family and many others.

The role of the regulator is to be a champion for patients, to expose poor care and to ensure that steps are taken to root it out. The regulator must do that without fear or favour, but it is clear that at Morecambe Bay, the CQC failed in that fundamental duty. We now have a new leadership at the CQC, and we should recognise its role in turning things around. David Behan was appointed chief executive in July 2012, and one of his very first acts was to commission the report that we are now debating. David Prior was appointed the new chairman in January this year, and has rightly insisted that the report be published as soon as possible. Those two outstanding individuals have never shrunk from addressing head-on the failings of the organisation that they inherited, and are wholly committed to turning the CQC into the fearless, independent regulator that the House would like to see. While I do not underestimate the challenge, I have every confidence in their ability to undertake it.

David Prior will now report back to me on what further actions the CQC will take in response to the report, including internal disciplinary procedures and other appropriate sanctions. The whole truth must now come out, and individuals must be accountable for their actions.

With respect to Morecambe Bay itself, an independent inquiry led by Dr Bill Kirkup started work earlier this year. More broadly, following the Francis report into the tragedy at Mid Staffs, the Government are putting in place far-reaching measures to put patient care and patient safety at the heart of how the NHS is regulated.

The CQC is appointing three new chief inspectors—of hospitals, social care and general practice. This will provide an authoritative, independent voice on the quality of care in all the providers that it regulates. The commission has already announced the appointment of Professor Sir Mike Richards as the new chief inspector of hospitals, and on Monday, the CQC launched a consultation, “A new start”, which outlines its much tougher regulatory approach. This includes putting in place more specialist inspection teams with clinical expertise. It will include Ofsted-style performance ratings so that every member of the public can know how well their local hospital is doing just as they do for their local school.

The Government will also amend the CQC registration requirements so that they include an emphasis on fundamental standards—the basic levels below which care must never fall, such as making sure patients are properly fed, washed and treated with dignity and respect. Failure to adhere to these will result in serious consequences for providers, including potentially criminal prosecution. The revised registration requirements will also include a new statutory duty of candour on providers that will require them to tell patients and regulators where there are failings in care—a failure clearly identified in today’s report.

Finally, we are putting in place, through the Care Bill, a new robust single failure regime for NHS hospitals. This will provide a more effective mechanism to address persistent failings in the quality of care, including the automatic suspension of trust boards when failings are not addressed promptly.

The events at Morecambe Bay, Mid Staffs and many other hospitals should never have been covered up, but they should never have happened in the first place, either. To prevent such tragedies we need to transform the approach to patient safety in our NHS.

The Prime Minister has therefore asked Professor Don Berwick, President Obama’s former health adviser and one of the world’s foremost experts on patient safety, to advise us on how to create the right safety culture in the NHS. He and his committee will report later this summer.

In addition, later this year we will start to publish surgeon-level outcomes data for a wide range of surgical specialties. Most of all, we need a culture where, from the top to the bottom of NHS organisations, everyone is focused on reducing the chances of harming a patient in the course of their care, and a culture of openness and transparency to ensure that, when tragedies do occur, they are dealt with honestly so that any lessons can be learnt. Our thousands of dedicated doctors, nurses and health care assistants want nothing less. We must not let them down, or any of the families who suffered so tragically in Morecambe Bay. I commend this statement to the House.

I thank the Secretary of State for his statement and for early sight of it, and I welcome what he has just said. Today’s report will have left people stunned. The Secretary of State began with an apology and we on the Opposition side echo it. It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What is never acceptable is when people or organisations try to hide those mistakes. As Professor Sir Liam Donaldson, the former chief medical officer, says:

“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Sadly, that is precisely what appears to have happened in this case.

The report covers a four-year period from autumn 2008 to autumn 2012. It details failures in regulation, but also subsequent attempts at a cover-up. It was published only because of the efforts of James Titcombe and his family. Like the Secretary of State, I pay tribute to them today, as does my hon. Friend the Member for Barrow and Furness (John Woodcock), who has supported the family. As he rightly said, that family’s suffering has been intensified by the actions of the NHS—something that should never happen. It is now essential that they and all the other Cumbria and Lancashire families affected get all the answers they are looking for—and I fully commit the Opposition to making sure that happens.

The most shocking revelation in this report is that, in March 2012, an instruction was given by a member of senior management at the CQC to “delete” the findings of a critical internal review. Let me remind the House of the context in which that March 2012 instruction was given. At that time, we were midway through a major public inquiry into the terrible failings at Mid Staffs. This was two years after the completion of an earlier independent inquiry—also led by Robert Francis, QC—following which all parts of the NHS had committed to full openness and transparency. It also came after failings at other trusts—most notably Basildon and Thurrock—which led me to request an in-depth look at all hospitals so that problems could be flushed out and a system put in place to ensure that people had a comprehensive picture of local standards. That was the context in which this instruction was given, and it explains why today’s revelations beggar belief and are hard to comprehend. The report raises questions for the CQC and the Department; I will take each in turn.

The new chief executive, David Behan, commissioned this report and we pay tribute to him for doing so. The chair has said today that he now wants to draw a line under this issue, but does the Secretary of State agree that it will be possible to do that only when further questions raised by this report are answered?

On hospital regulation, there is a recognition on all sides that it has not been good enough for too long. While we note the important work of Don Berwick, should we not also be getting on with the job of implementing the recommendations of the three-year Francis report in this regard? The Secretary of State mentioned a duty of candour on providers, but he will know that Robert Francis recommended that that should extend to individual clinicians, too. Will the right hon. Gentleman work with the Opposition to implement that recommendation as soon as possible?

On the cover-up, paragraph 1.17 of today’s report says that the order to delete

“may constitute a broader and on-going cover-up.”

Will the Secretary of State address that point directly and tell the House whether he is confident that this cover-up is no longer happening? Is he satisfied that the CQC has taken all appropriate steps, and does he have full confidence in it going forward, or does he believe a further process of investigation is necessary?

More specifically, is anybody who was involved in the decision to delete still working at the CQC or elsewhere in the NHS? If they are, people will find that hard to accept and they will want answers on that specific point. Given that accountability is essential, does the Secretary of State agree that people will find it hard to accept if data protection laws stand in the way of that accountability, and will he therefore review the decision to shield the identities of those involved? Today’s report makes it clear that the “deleted” report still exists. Should it not now be published?

Now let me turn to the Department of Health. Was the decision to delete taken solely by senior management at the CQC or is there evidence that anyone outside the CQC was either involved in the decision or aware of it? Was anyone in the Department of Health aware of the internal report being produced, and did any contact take place between the CQC and the Department running up to the decision to delete it?

Unfortunately, this matter does not end with deletion of the report. The Prime Minister said earlier that there should always be support for whistleblowers, and he was right, but there are serious doubts about whether that has happened in this case. Concerns about the CQC were raised by an internal whistleblower who was on the board. We know there was an attempt to remove her from the board and to question her character. Has the Secretary of State looked into these issues and considered whether appropriate support was provided—by both the CQC and the Department—to the individual who raised these concerns? The same whistleblower told the CQC today that she had raised issues internally first, then within the Department and then directly with the former Secretary of State in a meeting. Will the Secretary of State provide details of that meeting and publish a minute of it? What actions were taken by Ministers subsequent to that meeting? Were Ministers consulted about the decision to remove her from the CQC board, and did they support that decision?

Finally, the only real answer to all of these deep-rooted problems that go back a long way is for both sides of the House to recommit to full openness and transparency in the national health service. Will the Secretary of State join me today in restating that commitment and together sending the clearest and most unambiguous signal we can to the rest of the NHS?

In conclusion, there are difficult questions here for people at every level of the system. If we are to restore confidence, it is essential that they are answered and that people are held accountable for their actions. Learning from this failure and others, this House must a deliver a regulator that the public can trust, one that puts patients before its own interests. We will support the Government in that process and not stop until it is completed.

I welcome much of what the right hon. Gentleman says, but let me say this: he talks about getting on with implementing the Francis report, and that is exactly what has been happening. The report came to the House on 6 February. A new chief inspector of hospitals was appointed by 31 May, and the new inspections will start towards the end of this year. That will mean that many of the things talked about in the Francis report as being fundamentally important will start to be looked at independently and rigorously for the very first time.

I can confirm that there will be a duty of candour in the new Care Bill. We are looking at the extent to which it should apply to individuals, but we want to wait until Professor Berwick produces his report, because it is important to create a culture of openness, and we do not want to pass a measure that might inadvertently mean people clam up when they see a potential safety breach. We need to encourage an atmosphere where everyone talks openly about any concerns they have.

David Prior will be looking in his response to today’s independent report at whether anyone still working in the NHS, or, indeed, the CQC, may have been responsible for some of the shocking things that have been revealed. He will pass that report to me within the next two months. As I said in my statement, there will be full consideration of any sanctions or appropriate disciplinary procedures. In our response to the Francis report, we have said we want to introduce a new barring scheme to make sure that managers who have been found guilty of behaving in a bad way do not get jobs in another part of the NHS.

With respect to what the right hon. Gentleman said about my colleague, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), I gently say to him that it was not my right hon. Friend or myself or this Government’s Ministers who rejected 81 requests for a public inquiry into what happened at Mid Staffs. My right hon. Friend was the person who called the public inquiry into Mid Staffs. He is the person who changed the management of the CQC. He is the person who put clinicians in charge of budgets in the NHS, precisely to make sure these kinds of safety issues do not arise.

Finally, the right hon. Gentleman talks about accountability. If the Opposition really wanted to give confidence that they take the issues raised today seriously, they would recognise that it was fundamentally wrong to set up an inspection regime that was not carried out by specialists, and where the same person was inspecting a dental clinic, a slimming clinic, a hospital or a GP practice, perhaps in the same month. That may have contributed to the CQC’s decision in 2009 not to investigate the maternity deaths at Morecambe Bay, and to its decision in April 2010 to register the hospital without conditions.

When it comes to accountability, the right hon. Gentleman needs to explain to the House why the former head of the CQC, Barbara Young, said in her evidence to the Francis inquiry:

“We were under more pressure…when Andy Burnham became minister, from the politics.”

Is it the case that the head of the CQC felt under pressure not to speak out about care issues?

On the substantive policy point, the right hon. Gentleman continues to criticise the appointment of a chief inspector of hospitals and continues to criticise me when I single out hospital management who coast when it comes to raising standards. Just how much evidence will it take for the right hon. Gentleman and the Labour party to realise that when it comes to NHS policies, they really need to change?

As Member of Parliament for Lancaster, which is covered by the Morecambe Bay trust, may I reassure the Secretary of State and the House in general that thousands of my constituents are receiving a good service from hundreds of hard-working NHS doctors and nurses at the Royal Lancaster Infirmary? Does he think the problems began with the setting up of the CQC on 1 April 2009, and its being appointed as an independent regulator and being expected by the previous Government to inspect and register 378 NHS trusts within 12 months, by April 2010, which was an impossible target for any system to cope with?

My hon. Friend is absolutely right. That regime was utterly flawed, and as far as we can tell, inspectors looking at hospitals and care homes had targets of inspections they had to complete in a way that was totally counter-productive to the concept of a rigorous, thorough, independent inspection where people speak out without fear or favour when they find problems.

I also thank my hon. Friend for the other point he makes: that the people who work at the University Hospitals of Morecambe Bay NHS Foundation Trust are working extremely hard and under great pressure. I think they are doing a very good job by and large, but there are clearly very severe problems with the trust that we need to get to the bottom of, and it is very important that we recognise that if we are going to create a safety culture in the NHS, we need to back the people on the front line. They did not go into the NHS to have to deal with these terrible breaches in health and safety; they went into the NHS because they care for people and they want to do the best for people at their most vulnerable.

May I first thank the Secretary of State and the shadow Secretary of State for those words of apology to the Titcombe family and other families who have long been pressing for an inquiry and this kind of day of reckoning for the CQC? It is hard to imagine what it must be like to lose a child, but then to be faced with an almost impenetrable wall of bureaucracy, with one organisation and one group of people passing them over to another group, and with all of them ultimately washing their hands of accountability, is truly shocking. That has been laid bare in this report, and I commend its authors for bringing it to the attention of the public.

What the Secretary of State says about the staff in this trust is very important, because these are front-line people who have been failed by poor leadership and a poor inspection regime, which absolutely has to change.

The report says the particular issue here

“may constitute a broader and ongoing cover-up.”

Is the Secretary of State satisfied that that is not the case? If he is, how can he be? What can he do to look more widely than just at the CQC itself when looking into this allegation?

First, may I say I agree with what the hon. Gentleman says, and commend him on his work with his constituents and local families who have suffered so terribly from what happened? He is absolutely right to say we have created a system that is a nightmare for families who identify problems, and the real problem is a lack of clarity as to where the buck stops: where the buck stops in terms of the decision to say that a hospital is safe or not safe, and where the buck stops in terms of sorting out a problem when it is identified. Those are the areas where we are putting through big changes this year, as a result of the Francis report.

I completely understand why the issue of whether there is a continuing cover-up is a concern. All I can say is that I have total confidence in the new leadership of the CQC. They are on the side of the public. They understand that the CQC’s job is to be the nation’s whistleblower-in-chief. They absolutely get that, but changing the culture in the broader NHS takes more than the appointment of two new individuals at the CQC; it takes a complete change in the leadership so that people on the front line always feel supported if they want to raise safety concerns. That is a much bigger job. I do not want to pretend that we are going to be able to solve it overnight, but that is the big change we have to make.

My constituents can be forgiven for wondering whether, when the watchdog chooses to muzzle itself, it is time to put it to sleep. The report shows that the CQC discovered the truth about the deaths of babies at Furness General, but chose to suppress the truth, and to seek to subvert the Freedom of Information Act—and this morning I have asked the police to investigate that point.

Grieving families like the Titcombes deserve to know who made these decisions, so will the Secretary of State agree to ensure the removal of anonymity for those guilty of putting institutional convenience ahead of the lives of mothers and babies?

I completely agree with my right hon. Friend about backing those on the front line, but we have a culpable ex-chief executive of the trust on a £200,000 payout while the excellent nurses and doctors in the trust are struggling under immense pressure, so will he agree to work with me and all colleagues across Morecambe Bay to help the trust recover, which includes agreeing not to now demand that the trust make £25 million-worth of savings by March, as that would further threaten the pursuit of patient safety?

I agree with much of what my hon. Friend says. He is absolutely right that accountability for what went wrong is crucial in this. I know that the CQC wanted to publish the report in full today, including the names of the individuals involved, but was given legal advice that it would be against the law to do so. However, the CQC is keen to have maximum transparency as soon as possible and is looking into how it can make sure that happens. There should be no anonymity, no hiding place, no opportunity to get off scot-free for anyone at all who was responsible for this. This is the problem we have to address in the NHS: all too often, people are not held accountable for what went wrong. However, the system also bears responsibility. This is not just about bad apples and how we root them out more quickly; it is also about creating a system that brings out the best in people—that plays to the decent instincts that got people to join the NHS in the first place, rather than making them think that targets at any cost matter more than the care and dignity of the patients in their trust.

The CQC’s chairman said on the radio this morning that he could not publish the names of those responsible for this scandal because of the Data Protection Act, but there are clear and explicit exemptions to the Act when it comes to

“protecting members of the public from dishonesty, malpractice, incompetence or seriously improper conduct, or in connection with health and safety”.

Will the Secretary of State please challenge the CQC’s interpretation of the Act and, if necessary, ask the Information Commissioner to rule on this flawed decision?

I can reassure the right hon. Gentleman that neither the chairman of the CQC nor I have any interest whatsoever in keeping these names secret. He did receive legal advice telling him that he could not publish them, but I will go back to him with what the right hon. Gentleman says. I know that the CQC chairman would like to be as transparent as possible. The choice he had, on the basis of the legal advice, was either not to publish the report or to publish it without the names. I think he took the right decision, given the advice he had, but I will ask him to consider what the right hon. Gentleman says.

It is appalling what has come out in the press today and it is appalling what has been suppressed in the past. It is alleged by Lady Barbara Young, a former CQC chair, that under the previous Labour Government she was leant on by Labour Ministers not to criticise the NHS under their tenure. In her Mid Staffs inquiry evidence she stated:

“There was huge government pressure, because the government hated the idea that…a regulator would criticise it”.

She also alleges that the right hon. Member for Leigh (Andy Burnham), the then Health Secretary in the last Labour Government, needs to answer these very serious allegations, especially given what has happened in my local NHS trust.

That is the big culture change we need to see; we need to see Governments who are prepared, in all circumstances, however difficult and however politically inconvenient it is, to recognise that when there are safety issues, when there are terrible failures in care and compassion, we need to support the people who want to speak up, because if we do not do that, we will never root out these problems.

I support the comments made by my right hon. Friend the Member for Exeter (Mr Bradshaw). A real concern is being expressed by Members on both sides of the House, because a person committed this cover-up by deleting this report and we really want to know—there should be an investigation—whether they are currently working for the CQC or working in the NHS anywhere. It is vital to know that.

Today, the CQC’s chair has said that it is not currently capable of carrying out hospital inspections. The Health Secretary has talked about putting in place more specialist inspection teams, and I, of course, support that. However, CQC inspectors have had access to specialists for a long time—they have talked about it before the Health Committee—so if they are not using them, that is an issue to address. What measures will the Health Secretary put in place to ensure that from this day onwards—not at some future point—we can have the CQC competently carrying out inspections?

When the CQC was set up in 2009, it was decided, with full ministerial approval, to go for a generalist inspection model—a model where inspection was not carried out by specialists; the same people would inspect dental clinics, GP practices, hospitals and slimming clinics. That was the wrong decision to take. Making sure that we have enough specialist inspectors in place, with appropriate clinical expertise, takes time—it is a very big recruitment job—and that is what the new chief inspector of hospitals, Professor Sir Mike Richards, is now setting about doing. It is also expensive—it costs money—but he has said to me that when his teams are in place he will start those inspections before the end of this year. So we are going as fast as we possibly can to try to put these problems right.

My wife gave birth to all three of our children at the Royal Lancaster Infirmary, which is part of the University Hospitals of Morecambe Bay NHS Foundation Trust. Although the midwifery care was excellent, when we had complications with the third my wife received such neglect and ill treatment, at about the same time as Joshua Titcombe’s death, that the trust resorted to lying to us. No one should have to endure that treatment.

I have with me a litany of complaints, ignored by the management, the non-execs, and the Department of Health, going back to 2005. Constituents were lied to and nothing was done—no one came to help. I support the Secretary of State’s attempt to reform the CQC, but may I urge him to sort out governance at a more local level? Unless we improve the non-execs and the chairs of these trusts, none of these reforms will make a difference. Unless we improve clinical leadership, as well as managerial leadership, it will all be for nothing.

My hon. Friend speaks extremely wisely, and I know that the whole House will want to say how sorry we are to hear about the personal problems he had with that trust. All the international safety studies say that if we are to transform safety culture, it has to come from better leadership. It has to come from leadership that really cares; that frees up people on the front line to raise safety concerns in a way that they do not feel will be career-threatening; that encourages them to rethink procedures to minimise the risk of harm to patients; and that encourages the open and transparent approach that has enabled hospitals such as Salford Royal to become one of the safest in the country, because of the inspirational leadership of David Dalton. That change in leadership is fundamental, but having a chief inspector who goes without fear and favour and says where we have that leadership and, more importantly, where we do not have it, will be vital to ensuring that we start to get the changes that my hon. Friend is concerned about.

Does my right hon. Friend agree that in the long litany in this report of events that were inexplicable and completely unacceptable, one of the most inexplicable and unacceptable things it lays bare is that at the same time as concern was being expressed to the CQC about the quality of maternity services delivered in the trust, to which the CQC did not respond, the trust itself commissioned a report into the future of maternity services and did not see fit to report the existence of the Fielding review to the regulator to which it was responsible? Will my right hon. Friend make it crystal clear that that is completely inconsistent with any concept of duty of candour for health care deliverers?

I could not agree more with my right hon. Friend. What happened beggars belief, and I very much agreed with his comments on that on the radio this morning. The point about duty of candour is that there will be a criminal liability for boards that do not tell patients or their families where there has been harm and that do not tell the regulator; boards will have a responsibility to be honest, open and transparent about their record. That has to be the starting point if we are going to turn this around.

The public will be horrified, but probably not surprised, to hear that Ministers were leaning on the CQC not to criticise NHS hospitals. Leadership has to start at the top, so will the Secretary of State confirm that he will be fearless in standing up for whistleblowers and those protecting patients in the NHS? [Interruption.]

I thank my hon. Friend for that. She is absolutely right to say that the biggest responsibility Ministers have when faced with such tragedies is to be open and transparent about the scale of the problems; otherwise, they will never be addressed. Let me put it this way: people who love the NHS and are proud of it are the people who most want to sort out these problems when they arise. That is why it is incredibly important that we are open and candid. [Interruption.] The right hon. Member for Leigh (Andy Burnham) has stood up and criticised me in the media every single time I have given a speech drawing attention to some of the problems facing the NHS. He needs to be very careful every time he does that, because I will continue to do this, and I do it because I want the NHS to get better and believe it can be better.

James Titcombe this morning spoke of ministerial pressure on the CQC. Further to the statement by the right hon. Member for Leigh (Andy Burnham) about full transparency and the fact that data protection should not be an impediment, will the Secretary of State have discussions with him as to whether, within the very narrow remit of the Department’s dealings over Morecambe Bay with the CQC, he will apply full transparency to his involvement in this issue?

I echo the sentiments of the right hon. Member for Exeter (Mr Bradshaw) and ask the Secretary of State to look urgently at the application of the Data Protection Act if accountability is to mean anything at all. I urge him also to look at the lessons that a change of leadership effected in the CQC and the era of transparency that that heralded. There is a cover-up which is not just about Morecambe Bay; it is about Mid Staffs, and I suspect that, sadly, other stories may emerge of other such horrors. Does my right hon. Friend think there should be an inquiry into the culture of lack of transparency and cover-up that involved senior managers, and will he consider a change of leadership in order to herald a proper culture change in the NHS?

My hon. Friend has campaigned with great assiduity and distinction on this issue. The report about the culture of cover-ups and secrecy was the Francis report, and my job now is to do what is necessary to bring forward the change so that we move on and have a culture of openness and transparency. That means, yes, openness and transparency in this place and among Government Departments and regulators, but it also means creating a culture for front-line staff where they feel that they can raise concerns. We do not do that as well as we should, and it is even more important.

I share a great deal of the sentiments that the Secretary of State has expressed. He said at the Dispatch Box that the involvement of lay inspectors in the CQC was a problem, yet the Keogh review, which I comprehensively support, is involving significant numbers of lay inspectors. Does the Secretary of State agree with that approach? Is it the right or the wrong way forward?

As I understand it, the terms of reference, the way it is conducted and the timetable for the review happening at the moment are being set independently, but we should give every support to the people doing that review to make sure that they have access to the clinical expertise they need.

I very much welcome the Secretary of State’s desire to see published appropriately contextualised surgical outcome data for each surgeon. Those surgeons, however, have to work within structures created by managers, so in the interests of transparency would he support the publication of each manager’s performance so that the public can see where failure is taking place? First, that could prevent the merry-go-round of jobs, Cynthia Bower being the classic example. Secondly, appropriate financial penalties can be applied to the said managers if they fail, as they clearly have done in Morecombe.

My hon. Friend speaks extremely wisely. One of the key issues raised by the Francis report was the fact that we have a form of accountability for doctors and nurses—it does not always work as well as it should—through the possibility of being struck off by the GMC and the Nursing and Midwifery Council, but there is no equivalent accountability for managers. In a way, that is what the chief inspector is going to do. That is why I was so keen that as well as looking at whether a hospital is safe or not, the chief inspector should rate hospitals with Ofsted-style rankings, which look clearly at the quality of leadership in every organisation. The score that a hospital or a trust gets from the chief inspector will ultimately be the determinant of whether or not an organisation is well led. That is why I think it will give the public vital information about leadership, which they do not have at present.

As the Secretary of State knows, there have been issues about patient care in the North Cumbria University Hospitals NHS Trust. I therefore fully support the introduction of a more robust CQC regime than the one that previously existed. What does the Secretary of State intend to do to ensure that failing trusts are taken over in a timely and efficient manner so that new leadership and new management may be put in place as soon as possible?

My hon. Friend speaks well. Even under the current system, when problems are identified they seem to fester without being properly addressed. Under the new single failure regime for hospitals, when failure is identified there will be a maximum period of one year to sort it out or the board’s trust will be suspended. There will be a cut-off which does not exist at present to make sure that the local NHS, the trust board and, in the end, even Ministers bite the bullet when there are problems so that we do not allow them to continue.

After Francis, after the Health and Social Care Act 2012, are we not asking a deeply dysfunctional and damaged organisation to shoulder additional responsibilities? Is not that in itself risky? In the Secretary of State’s statement he mentions “potentially criminal prosecution” of providers. Exactly who will be prosecuted? Managers? Clinicians? Board members? And exactly on what charge?

The criminal sanctions apply to boards for withholding information about safety breaches at their trust, and as I mentioned earlier, we are considering whether those sanctions should apply below board level. We want to wait for Professor Berwick’s advice on that, because there is a balance between proper accountability for mistakes and the need to create that culture of openness, where people report mistakes that they might see a colleague making, which might not happen if they were worried about criminal prosecutions. I want to take the advice of an expert on that.

I and the people I represent are rightly proud of our NHS. However, from Morecambe Bay to Mid Staffordshire we have had a series of scandals. Can the Secretary of State reassure patients that the previous Government’s culture of secrecy and neglect will now be torn apart and replaced by a new, transparent, accountable health service that treats patients with dignity, rather than as numbers?

The big challenge of our times for the NHS is to make that culture change, and it is a huge organisation. With 1.3 million people, we will do this only if we tap into and harness the desire that they have to do their jobs to the highest standards of patient safety, treating people with dignity and respect. That will be the key to unlocking success.

The Secretary of State rightly said that individuals must be held accountable for their actions. To what extent does he think some former Labour Ministers were complicit in this disgraceful cover-up?

They need to explain why Barbara Young made the comments that she did. I think there was a general desire to talk up the NHS and not to talk about some of the very deep-seated problems that have now come to light. It is our duty in all parts of the House to make sure that we have a more mature discussion about the NHS when problems arise, and that we do not always seek to throw party political stones but recognise when problems arise. We should talk about them, not cover them up.

I attended a presentation given by the CQC in early 2011 and I was shocked at the low calibre of what I heard. In particular, I found the CEO at that time to be out of her depth. My right hon. Friend will know that the individual concerned was previously CEO of the West Midlands strategic health authority between 2006 and 2008, at the time of the scandal of Mid Staffs. Will my right hon. Friend say a little more about what he plans to do to improve the appointment process for senior positions in the wider health service to ensure that proper scrutiny of people’s prior performance takes place?

That is a very good question from my hon. Friend. We need to make sure that we have absolutely the right people in place. One of the lessons that we have learned from Ofsted, which has been an extremely successful regulator in the education sector, is that what works is having people who are prepared to speak truth to power—who are prepared to say uncomfortable things even to the people who have appointed them. I have had this conversation with Mike Richards, because I have the highest opinion of Mike, and I also know that he will say things while I am Secretary of State that will make me deeply uncomfortable. We have to understand that part of the way that we will make sure that the NHS is and continues to be one of the very best health services in the world is having that rigour in the inspection process.

Many families in Bury, Ramsbottom and Tottington in my constituency will have elderly relatives living in care homes, which they will have chosen on the basis of CQC assessments. Can my right hon. Friend reassure them that these care homes, inspected and approved by the CQC, are in fact up to standard?

We have not talked very much about care homes during these questions, but anyone who saw the horrific “Panorama” programme earlier this week on the BBC will know that there are some appalling problems in some of our care homes. We need that same independent, rigorous inspection in care homes as well. That is why, alongside the chief inspector of hospitals, we are appointing a chief inspector of social care who will once again—it is a great shame that we stopped doing this—rate care homes on the quality of care that they give and speak without fear or favour, so that we can reassure my hon. Friend and his constituents.

Last week and this week, the Secretary of State has made bold and helpful statements in the interests of NHS accountability, and I commend him for doing that, but does he accept that we have a real problem in the structure of democratic accountability in the NHS? As he knows, there has been great leadership, including from some of his Back Benchers, and will he commission a review now so that we can all have confidence that there is a proper democratic structure of accountability to oversee all parts of the NHS?

I thank the hon. Gentleman for his comments, and I hope that he will bear with me as the profound changes that we are introducing this year are rolled out. The most important element of democratic accountability is making sure that the public have the same information as the experts, so that they know whether their local hospital, GP surgery and care home are doing well. That is one of the biggest imbalances and that is why I am putting a lot of emphasis on the new chief inspectors, who will have the status, authority and resources to make those judgments, so that the public know what sometimes only the system has known. Then we will help to address some of the issues that he raised.