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Special Measures Regime

Volume 584: debated on Wednesday 16 July 2014

With permission, Mr Speaker, I would like to make a statement about hospitals in special measures, and the next steps for rolling out a new inspection regime in the social care sector.

One year ago in the wake of the Francis inquiry, Professor Sir Bruce Keogh delivered his report into NHS hospitals with the highest mortality rates. Shockingly, he found that the poor care swept under the carpet for four years at Mid Staffs was not an isolated incident or “local failure” as some have claimed, and he recommended that 11 trusts should be placed into special measures. As a result of the new independent hospital inspection regime introduced by this Government, a further five trusts have been placed into special measures, taking the total to 16 trusts—more than 10% of all acute trusts in the NHS in England. Today I am reporting back to the House on the progress of the first trusts to be put into special measures, and on how the lessons we have learned can be applied to adult social care.

I would like to start by thanking all the front-line staff who have been involved in the special measures process, which can often be traumatic and stressful, with difficult media coverage in local and national newspapers. Thanks to their superb efforts, I am pleased to report today that progress is being made in nearly every trust and that the chief inspector of hospitals has recommended that five should now come out of special measures. Together with Monitor and the TDA—the NHS Trust Development Authority—he will shortly be publishing a report of his findings.

Across all the initial special measures trusts, leadership capability was carefully reviewed, leading to 53 changes at board level. A hundred more doctors and 1,300 more nurses and nursing support staff have been recruited. Every hospital has put in place a comprehensive improvement plan and was partnered with at least one other high-performing hospital, giving access to best practice and hands-on guidance and assistance.

The chief inspector and Monitor have confirmed that Basildon and Thurrock NHS Foundation Trust can leave special measures with no further support. Under Clare Panniker’s inspired leadership, the trust has appointed 241 additional nurses and has been given a “good” rating overall, with its maternity unit the first in the country to be rated “outstanding”. The chief inspector has recommended that George Eliot NHS Trust should also exit special measures, with a new acute medical unit, 31 more doctors and a strong partnership with University Hospital Birmingham NHS Foundation Trust.

The chief inspector and the TDA have confirmed that Buckinghamshire Healthcare NHS Trust, where there has been good progress on staffing, nutrition and hydration, should also leave special measures, with some continued support in place. The chief inspector has recommended that East Lancashire Hospitals NHS Trust, with some 238 more nurses and nursing assistants in place, should also exit special measures with some continued support. He has recommended that Northern Lincolnshire and Goole Hospitals NHS Foundation Trust should also leave special measures, with some continued support in place, having improved stroke care and employed 166 extra nurses and nursing assistants.

While United Lincolnshire Hospitals NHS Trust has made progress, including the employment of 140 additional nursing staff, work remains to be done, and the chief inspector has recommended that it should remain in special measures for a further six months. Turning around a hospital which had significantly high death rates going back to 2006 is a big task, but I know, having visited the trust myself, how much enthusiasm there is to exit special measures.

At North Cumbria University Hospitals NHS Trust, a further 90 nursing staff have been employed, and mortality is now within normal limits. However, the chief inspector has recommended that further progress is still needed, although we are hopeful that this will be completed within six months. At Tameside Hospital NHS Foundation Trust, while staff are reporting a better leadership culture and there have been improvements on some key safety indicators, he recommends a further six months in special measures to ensure that sustainable improvements really are in place.

The chief inspector continues to have strong concerns about Medway NHS Foundation Trust—an organisation with long-standing difficulties, care failures and high mortality rates going back to 2005. He recognises some progress, including the recruitment of 113 nurses, but has concerns about the sustainability of those improvements. He will make his recommendations about Burton Hospitals NHS Foundation Trust and Sherwood Forest Hospitals NHS Foundation Trust in the next few days, following their local quality summits.

All the Care Quality Commission’s recommendations will need to be fully considered by Monitor or the TDA before they are confirmed. I pay particular tribute to the work done by the chief inspector and his team from the CQC, and to Monitor and to the TDA, for the extraordinary effort they have put into making the improvements outlined above.

However, the responsibility for safe and compassionate care goes far beyond hospitals. Hundreds of thousands of people—some of the most elderly and vulnerable in our society—receive care in their own homes or in residential and nursing homes. Yet in recent years a member of the public, Jane Worroll, discovered from a secret camera that her mother was being systematically abused in Ash Court care home in London. Another secret camera filmed a resident being slapped and mocked at the Old Deanery home in Essex earlier this year. Perhaps most shocking of all was, in the words of the West Sussex coroner, the “institutionalised abuse” handed out to the residents of the Orchid View care home in Copthorne, where five people were found to have died as a result of poor care. The long list of failings included residents being left in soiled sheets, call bells ignored or left out of reach, and medications mismanaged.

Every older person has a right to be treated with dignity and respect in the way we would all wish for our own parents and grandparents. This Government are determined to see demanding standards and tough enforcement apply as much outside hospitals as inside.

Inexplicably, the previous Government scrapped expert-led inspections of adult social care organisations—as they did for hospitals. The same individuals, therefore, might have been inspecting a large teaching hospital and a small care home in the same week without any opportunity to develop the detailed expertise necessary to make important judgments.

Today I can confirm that we are bringing back expert-led inspections for adult social care, and I am encouraged that the new chief inspector of social care, Andrea Sutcliffe, has announced the toughest ever enforcement regime, to ensure that ongoing abuse and neglect in residential care homes and domiciliary care services is stamped out once and for all.

Alongside the new programme of rigorous and independent inspections, the CQC is being given the power to produce ratings of care providers that will provide a fuller picture of the quality of care than mere compliance with minimum standards. The first ratings will be published in October.

New fundamental standards of care will also be introduced, which will allow the CQC to prosecute those responsible for unacceptable care. In addition, we are introducing safeguards that will allow the CQC to remove and bar individual directors.

I can announce today that once in special measures, care services will be given six months to shape up or action will be taken that will lead to them closing down. This regime will start next April. From then, any care service rated as “inadequate” under the new ratings system will be required to improve within a time-limited period. The CQC will then take action to close down any services that do not meet the standards that people have a right to expect.

My Department and the CQC will work with the sector on the details of that framework, including what support can be given to failing providers and the timing of any closures. In particular, the CQC will work with people using services, their carers and their families to ensure that no one suffers as a result of any service closing down.

We are taking these steps because we have a moral duty to our most vulnerable people to ensure that they receive the best possible care and that they are treated with compassion, dignity and respect. We also owe it to those many excellent providers who deliver good care every day and need proper recognition.

When this Government took the tough decision to confront the reality of poor care within the NHS, people said we were running down the NHS and its dedicated staff. But we refused to accept a status quo that tolerated poor standards, betrayed NHS values and, most of all, betrayed hard-working staff who have given their lives to the care of others.

As a result, we are finally turning around performance in failing hospitals—something we are today extending to social care. Much remains to be done, but after a traumatic moment in its history, both the NHS and the social care systems have faced the truth, confronted the past, and can now face the future with confidence.

I commend this statement to the House.

Anyone who supports the NHS must always be prepared to shine a light on its failings so that it can face up to them and improve. Therefore, I welcome much of what the Secretary of State has said today, and I join him in thanking Sir Mike Richards and Sir Bruce Keogh. Their work builds on foundations laid by the previous Government, and I do not think the Secretary of State helps his case today by continuing to make assertions not supported by the facts. Let me once again gently remind him of the broader context.

It was following care failures in the 1980s and 1990s that independent regulation of the NHS was introduced for the first time by the previous Government. It was that independent regulator that, as Sir Bruce Keogh said, helped reduce mortality in all NHS hospitals over the past decade and then uncovered problems at Mid Staffs.

The Secretary of State was right to say that Mid Staffs needed to be a moment of change for the NHS. The central lesson of the first Francis report, which I commissioned, was that staffing levels were critical to safe care. The big question that arises is for this Government to answer: why, following that report, did they fail to learn the lesson and allow staffing to fall across the NHS in the first three years of this Parliament? Nurse numbers were cut by almost 6,000 in the three years between July 2010 and July 2013, but the cuts fell particularly hard on some of the 11 trusts that we are considering today. North Cumbria cut 148 nursing posts, United Lincolnshire cut 179 and Basildon cut 345. When the Health Secretary was forced to put those trusts into special measures, it was because they were getting worse on his watch.

The Health Secretary mentioned Basildon—like him, I congratulate the trust and its staff on its improvement—but I left a clear warning in place about Basildon in 2010, following a statement I made to the House. Why on earth was it allowed to cut so many staff in the following three years when Francis had already warned of the dangers of doing so? I have an answer to a parliamentary question that shows that Ministers did not hold a single meeting about Basildon up to its being placed in special measures, presumably because they were distracted with their reorganisation. Will the Health Secretary now admit that it was an error to cut so many nursing staff, and will he today accept the National Institute for Health and Care Excellence recommendations on safe staffing levels?

Let me turn to the special measures regime. We welcome the improvements at some of the 11 hospitals and pay tribute to the staff, but it is a concern that four are showing only limited signs of improvement. One trust, Medway, has barely shown any, but how can that be after a year in special measures? Does it not raise questions about whether the regime is providing enough support to improve? A CQC inspection published last week found a catalogue of concerns at Medway—patients on trolleys overnight without appropriate nursing assessment, medication given without appropriate identification of patients, and insufficient nursing levels with an over-reliance on agency staff. The Secretary of State claims that all the problems are long-standing ones, but the CQC found that happening right now. The trust has been in special measures for one year. How can there have been no improvement, what is he doing to help Medway to improve, and given its worrying lack of progress, will he report back to the House at the first opportunity?

There are also questions about the inspection regime. Last week, it was revealed that in 2012 the CQC employed as inspectors 134 applicants who had failed competency tests, of whom 121 are still in place. Again, how was that allowed to happen? Is the Health Secretary confident in the ability of those inspectors, and if not, what is he doing about it?

Three of Cumbria’s four largest hospitals are in special measures. General practitioners are under severe pressure, and my hon. Friend the Member for Copeland (Mr Reed) relayed their warnings to the House yesterday. Is there not a much wider failure in the health economy, as he warned, and with an overly hospital-focused inspection programme, is there not a risk that wider problems in the heath economy are being missed? Is it not the case that hospitals are often dealing with pressures and problems not of their own making—but due to cuts to primary care, social care or mental health—and to be truly effective, should not the Health Secretary’s inspection regime take a much wider view of the whole health economy?

That brings me to social care, about which the Health Secretary is right to say that we have seen appalling failures in recent years at Winterbourne View, Orchid View and Oban Court. We welcome the extension of the special measures regime to care homes, but I must say that it sounds like a U-turn. Only recently, he legislated to remove the CQC’s role in assessing whether councils commission care effectively. Is he conceding that that was a mistake, and does he accept that it must be reversed if we are to have truly effective care inspection?

Local authority commissioning can be the root cause of care failures, but so can the impossible budget cuts that many providers now have to absorb. Is that not the real reason why we have such problems in our malnourished social care system today? New House of Commons Library analysis—we are publishing it today—shows that £3.7 billion has been cut from adult social care since 2009-10. That is not sustainable. How does the Health Secretary think that older and disabled people will ever get the standards of care to which he aspires with cuts on this scale?

The truth is that the collapse of social care is in danger of dragging down hospitals, which are becoming dangerously full of older people and struggling to function. The Health Secretary will not like to admit it, but in the year to the day since he stood at the Dispatch Box and made his first statement on the Keogh report, hospital accident and emergency departments have missed his own lowered A and E target in every single one of those 52 weeks. Does that not tell us more clearly than anything that it is not just a small number of trusts that have got worse on his watch, but the whole NHS? The cancer treatment target has been missed for the first time ever, it is harder to see a GP, and waiting lists have hit a six-year high. He does not just need a plan for some trusts; he urgently needs a credible plan to get the whole NHS back on track.

I had hoped for a little more consensus on the issue of dealing with poor care. I am afraid that what we had from the right hon. Gentleman was a set-piece speech. However, let me go through the points that he raised.

First, the right hon. Gentleman spoke about nursing numbers. Let us look at the number of nurses since the Government took office. We have 6,200 more nurses on our wards than when he was Secretary of State for Health. Why is that? It is because we took the difficult decision, which he opposed every step of the way, to get rid of the bureaucracy, the primary care trusts and the strategic health authorities—19,000 administrators—so that we could afford more nurses, more doctors, more paramedics and more front-line staff. It is time that he admitted that he was wrong to oppose those important reforms.

The right hon. Gentleman then talked about trusts missing A and E targets. Despite the fact that we are doing better on A and E than he did as Health Secretary, he has missed the point about targets. It was an obsession with targets under Labour that led to the problems in Mid Staffs and many of the trusts that are in special measures today. Let us just take one example. [Interruption.] The Opposition should listen to this example because it provides an important lesson about targets that the Labour party has still not learned. Buckinghamshire had a terrible tragedy in 2004 and 2005, when more than 30 pensioners died in a clostridium difficile outbreak. Why did that happen? The independent report said that the trust was too focused on Government targets.

That is the dividing line. The Opposition want an NHS that is obsessed with targets. The Government recognise that targets matter, but that treating people with dignity, respect and compassionate care matters. Is it not extraordinary that the party that founded the NHS has got itself into a position where it does not care how people are treated in the NHS?

The right hon. Gentleman talked about social care. If he wants more funding for social care, why has he called for the better care fund to be halted, when it will put an extra £1.9 billion at the disposal of the people who commission adult social care?

Let us look at some of the examples that the right hon. Gentleman raised. He talked about Basildon. When he was Health Secretary, the CQC sat on a report about that trust for six months that talked about bloodstains on the carpets, blood on the floors and vital safety measures being ignored. When the reason why the report was not published for so long was looked into, people at the CQC said that they were afraid to publish something that could embarrass the Government of the day. Is it not time that he admitted that the way the Labour Government ran the CQC was wrong? We now have an independent inspections regime, which is a big step forward.

The right hon. Gentleman talked about Cumbria. There are real issues in some of the hospitals in Cumbria. However, when Labour was in office, somebody in one of those hospitals—North Cumbria—was paid £3.6 million because they were disabled for life. Should that not have been a warning sign? There were also issues at Morecambe Bay involving children.

What are we doing? We are doing what I set out in the statement. We are putting more nurses and doctors into hospitals that are in special measures. We are turning around the failing hospitals that Labour swept under the carpet.

Even if Labour has not understood the lessons of Mid Staffs, the NHS has. We have 6,000 more nurses; five hospitals are out of special measures; there is record public confidence in safe and compassionate care; and, from today, we have new plans to stamp out poor care in adult social care. When everyone in the NHS is so keen for those plans to work, is it not time that Labour ended its denial about the past and backed them as well?

I congratulate my right hon. Friend on bringing back an expert-led inspection regime for adult social care. I ask him to learn from the experience with schools in Birmingham five, six or seven years ago, which managed to bamboozle Ofsted by planning for the inspections. I ask him to ensure that a good proportion of the inspections under the new regime have no notice whatsoever.

My hon. Friend, as ever on health issues, makes an extremely important contribution. She is right that we drew a lot of inspiration from the Ofsted regime, which is clear, transparent and easy for the public to understand. She is right that snap inspections are importation. I reassure her that the CQC has the power to perform snap inspections. It has already used that power and will continue to do so.

Does the Secretary of State agree that it is a tribute to the new leadership of Professor Eileen Fairhurst, the chair of the East Lancashire Hospitals NHS Trust, the other senior clinicians and managers, and the vast majority of staff at the trust, who are of a high quality, that the trust has been able to turn around and get out of special measures? Does he also accept that, as Professor Sir Bruce Keogh makes clear—these are my words, not his—it is essential that the trust does not take its foot off the gas, but continues the process of change and, above all, cultural change in the way that patients are treated? Lastly, although the additional nurses are welcome, will he say something about the implications for the future funding of the trust?

The right hon. Gentleman makes some important points. I will start with the point that provides a broader lesson for the NHS. Not taking our foot off the gas is really important. This is the start of a very long journey. I said last year that it would take about three years to turn around a hospital where the wrong culture has become entrenched.

I pay tribute to the leadership at East Lancashire Hospitals NHS Trust. The CQC report said that the staff on the front line now feel more supported, more empowered to take decisions and more able to raise concerns. If there is one thing that we have learned, it is that successful hospitals make it easy for their staff to speak out and support them in speaking out. The hospitals with problems are the ones where people feel bullied and intimidated when they speak out. I am delighted with the progress that has been made.

In respect of finances, this is a challenging time for finances across the NHS. I simply say that, as I am sure the leadership of the right hon. Gentleman’s trust recognise, the most expensive thing of all is delivering poor care. The most important way of saving money is ensuring that the care that is delivered is safe.

I very much welcome the changes the Secretary of State has announced on social care inspections. However, standards and enforcement alone are not sufficient. Does he agree that we need to look at the support that is provided to organisations so that they can change before they get to a point of crisis? If so, will he look at the work of My Home Life, which runs programmes to transform the lives of people in care homes and improve their quality of life by working with staff in a different way? I commend that work and hope that he looks at it.

I am happy to do that. I agree with the right hon. Gentleman. I would like to see a lot more innovation. Even in the best care homes, which deliver good care by today’s standards, there is room for much more innovation and imagination in seeing how we can make people’s last years ones that they really enjoy. I have seen some amazing dementia care homes that break the mould. I am very happy to look at the work of that organisation. I am sure that there is a lot we can all learn.

The Secretary of State said that 16 trusts are in special measures, but he mentioned only 11 of them. As he knows, Barking, Havering and Redbridge University Hospitals NHS Trust includes King George hospital in my constituency. Will he take this opportunity to explain why he has not said anything about that trust? Is it because the plans to close the A and E this year or next year are in total disarray, but he does not want to admit it publicly? Will he take this opportunity to clarify—yes or no—whether it is still his intention that King George hospital’s accident and emergency will close?

First, let me reassure the hon. Gentleman on the last point. The trust has made it absolutely clear that the change in A and E will not happen until it is safe. It is very unlikely that it will happen in the near or medium term. The reason I did not mention his trust is that the statement was about the 11 trusts that were put into special measures exactly a year ago and his trust was not put into special measures until just before Christmas. It, too, is making progress. It has employed 31 additional nurses, it has an excellent chief nurse, whom I have met on a number of occasions, it has had a new chief executive since April and there is an increase in patient satisfaction. However, there is still a long way to go because it is a very challenged trust with some deep-seated problems. We need to support it at every step of the way.

Today’s statement and the appointment of the chief inspector of hospitals arise from the Francis report on Mid Staffs in my constituency. I am sure my right hon. Friend acknowledges the great improvements that have been made at Mid Staffs thanks to the hard work of staff and others, but he will also acknowledge that the situation remains fragile. Will he ensure that both Stafford and the University Hospital of North Staffordshire are given the full support they need to come together and implement the recommendations of the trust special administrators in full, as a minimum?

I pay tribute to the staff in Stafford hospital. I also make the point that, even through the four years when those terrible examples of care happened in the hospital, much excellent care was happening, too, and the hospital had dedicated and hard-working staff. This has probably been tougher for them than for anyone else in the whole NHS. I thank my hon. Friend for the way in which he has campaigned for his local hospital. No one could have done more for their local services. I agree with him that we must implement the very detailed recommendations of the TSAs quickly and in full, and ensure that we give every bit of support necessary to both Stafford and UHNS to ensure that that merger works.

The Health Secretary talked about denial of the past, but that was a bit rich given that Conservative Ministers gave Jimmy Savile a managerial post at Broadmoor. He wants to think about that a bit more.

In view of the disgraceful care failures the Health Secretary detailed, I find it surprising that he relies on inspection to raise standards and ignores the obvious impact of cuts of £3.7 billion in social care budgets. Does he not see that inspection will not fix the parlous state of social care?

I am afraid that that is the difference between Government and Opposition Members. The hon. Lady says that there was denial over Jimmy Savile, but I stood at this Dispatch Box and apologised to relatives and members of the public for the mistakes relating to Jimmy Savile. I do not call that denial; I call it facing up to the past.

Of course, inspection is not the only answer, but the reason it was so wrong to abolish the expert-led inspections we used to have in social care is that the first step, if we are trying to improve standards, is at least to know where the problems are. Until we have those expert-led inspections, we will not know that. The next step is to work out how to solve the problems. We will be doing both.

The Queen Elizabeth hospital in King’s Lynn serves my constituency and that of the Secretary of State’s deputy, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). Will the Secretary of State pay tribute to the superb acting chief executive, Manjit Obhrai, and the former acting chairman, David Dean, who have done a sterling job, along with the hard-working staff, on the hospital’s comprehensive improvement plan? When will that hospital come out of special measures, and will he pay tribute to the excellent work that has been done in the past few months?

I am happy to do so. The hospital has recruited 95 more nurses and nursing support staff since last July. It has appointed a director of nursing and a medical director and lead for patient safety, which strengthens clinical leadership. Some very important changes have been made, and I pay tribute to the hospital’s leadership for making that possible. I hope my hon. Friend understands that, under the new system we have set up, it is not for the Secretary of State or any Minister to say when a trust is ready to come out of special measures. We have deliberately given that judgment to an independent chief inspector, so that no one who has a vested interest or a hope that a hospital will come out of special measures, and no one who is involved in turning around a trust, is responsible for that important independent judgment. However, that means that, when hospitals come out of special measures, people can have confidence that the judgment has been correctly made.

This is an important statement, but it is regrettable that the Health Secretary is implying that the care failures were all the fault of the previous Government. Will he confirm that Sir Bruce Keogh, who gave evidence to the Select Committee on Health yesterday, and not the Secretary of State, decided which hospitals would be placed in special measures? I understand that Sir Bruce’s decision was based on those hospitals being outliers for two consecutive years. According to my maths, that means that the failures described by the Secretary of State occurred on this Government’s watch. If he is apologising and feeling contrite, would he like to own up to that failure?

The examples of poor care I gave happened under this Government. I am therefore being absolutely clear that failures in care happened under both the previous Government and this one. The difference is that this Government are doing something about it. We are taking action and taking the difficult steps to get those trusts out of special measures. The public are beginning to have confidence that, when there are problems, they are not being swept under the carpet but being dealt with.

Bad care is unacceptable, but what turns bad care toxic is covering it up and denying that it is happening. I am pleased that we are beginning to get a consensus across the House that transparency and unearthing problems is the beginning of solving them. On that note, will my right hon. Friend the Secretary of State work on a cross-party basis with the right hon. Member for Leigh (Andy Burnham) and the Labour party on Wales, which was also targeted by Bruce Keogh’s expertise? He has suggested that it would be sensible to have a Keogh-style investigation in Wales, not only because of mortality statistics and diagnostic waiting times, but because tales coming to me and the right hon. Member for Cynon Valley (Ann Clwyd) are raising the alarm. I urge hon. Members on both sides of the House who are worried about patients in Wales to urge such an investigation there, because the investigation here unearthed problems.

I totally agree with my hon. Friend. It is an absolute tragedy for people who use the NHS in Wales and Welsh NHS workers that they are not getting the support that people in England get to deal with poor care. For some reason, the Labour Administration in Wales believe that it would be incredibly embarrassing to find problems, but that is what hospitals and hospital staff are crying out for. The staff did not go into those jobs to deliver poor care. They want the support to deliver the best care. It is time that Labour in Wales understood that and got the support of Labour in England to do so.

The Secretary of State will know that the local MPs covering Tameside hospital have never pulled their punches in calling for the need to improve our local hospital. He may recall that we publicly called for the previous leadership of our hospital to be removed even before the Keogh review process began. Speaking on behalf of my hon. Friend the Members for Denton and Reddish (Andrew Gwynne), who sits on the Opposition Front Bench, and my hon. Friend the Member for Ashton-under-Lyne (David Heyes), we are disappointed that Tameside remains in special measures, but we believe that progress has been made, particularly in A and E and with regard to mortality rates. We believe that the new management team, who have brought about those changes, deserve our support. We will never accept anything but the very best care in Tameside, and we agree that there is more to do, but we believe we are on a journey of improvement and that our hospital is in a different place from where it was 12 months ago.

I thank the hon. Gentleman for the tone of his comments and totally agree with his sentiments. Tameside has recruited 70 new nurses and nursing staff. To take one important indicator—it is only one—the number of falls has decreased by 18%. The staff definitely feel more supported by the management. However, he is right that this is a long process—the trust has been troubled for many years—and we are absolutely determined to back the staff and get them over the line.

Mortality rates at Medway are not as elevated as they were in 2005, but does the Secretary of State believe that the astonishingly well paid interim managers have made any sustainable improvements, and will he expand on how University Hospitals Birmingham will help us to drive improvements at Medway?

To be frank with my hon. Friend, the situation at Medway is still troubling. It has made some improvements to maternity services and has about 100 more nurses, and the dementia unit has made progress, but we have not had the stability of management and leadership that will be necessary to sustain improvement. It always takes a very long time to make such improvements. We will therefore work hard to do that. I hope that the partnership with UHB will be a part of that change, because Julie Moore is one of the best chief executives we have in the NHS. I will work closely with my hon. Friend, because I know he takes a great interest, to ensure that we get the lasting changes we need at Medway.

Sir Bruce Keogh focused on the A and E at Royal Blackburn, which I have had the privilege of visiting. However, Hyndburn faces significant NHS cuts, such as cuts to the walk-in centre, which 36,000 people have been through; cuts to the NHS GP practice in Accrington Victoria; and cuts to personal medical services GP contracts, which GPs are deeply concerned about, and which will lead to a reduction in hours. GPs tell me that that will impact on A and E. Is the shadow Secretary of State right to say that we should look not only at hospitals, but at the broader picture, if we are not to neglect patients and let them down?

If the hon. Gentleman is worried about cuts, perhaps he might talk to the shadow Secretary of State and ask him why he said it was irresponsible for us to increase the NHS budget as we did.

On the particular issue the hon. Gentleman raises, I actually agree with the shadow Secretary of State. It is not always possible to solve these problems simply by reference to the institution. Sometimes we have to look at the broader health economy. That is particularly true of A and E, but it is true for many other parts of the NHS too. Where there is a broader health economy issue we must look at that as well, but this process means that Ministers are held to account for finding a solution, whatever that solution is.

I join my right hon. Friend in his tribute to the front-line and managerial staff at North Lincolnshire and Goole NHS Foundation Trust. My constituents will particularly welcome the increase in staffing levels and the improvements in the stroke unit, which has been a particular concern. He will be aware of recent public criticism of the hospital trust by North Lincolnshire clinical commissioning group. Can he assure my constituents that the continuing help and support will focus on the aspects of its criticism?

That certainly needs to happen. I visited my hon. Friend’s trust and saw a knee operation. I talked to the staff about the special measures regime, and they said that they thought important changes were happening, so I was delighted too when they came out of special measures. We will certainly give all the support they need, and I thank him for the support he is giving his local hospital.

Does the Secretary of State agree that possibly the single most important factor in turning these hospitals around is the quality of the leadership? He has referred already to Tameside hospital, where the report talks of the staff reporting a better leadership culture. This hospital has suffered for far too long from inadequate leadership. I am confident that good leadership is in place now. The change in the hospital is palpable. I am confident that, given a fair wind, it can be out of special measures within the six months referred to, despite the severe underfunding with which the hospital management is grappling daily.

Funding pressures are everywhere in the NHS, but I agree with the hon. Gentleman’s sentiments that this is largely about leadership. As well as this work, we are working with Sir Stuart Rose to try to understand what we can better do to sustain and support the highest quality leadership. We have some great leaders in the NHS, but we probably do not have enough of them. I think there has been an improvement at Tameside. I strongly welcome that and we will certainly be supporting the leadership and the staff in that hospital every step of the way.

I congratulate my right hon. Friend on his statement. I, too, congratulate Clare Panniker on her inspirational leadership at Basildon hospital. She informs me that rather than cutting 345 nurses between 2010 and 2013, there were 1,908 in 2010, 2,000 in 2013 and that that number is now up by 241. Does he agree that to tackle problems in the NHS we need honesty and accuracy when discussing these issues?

We do. I think it is time that those on the Opposition Front Bench, in particular, recognised that they were wrong to oppose so bitterly the move to get rid of 19,000 administrators in the NHS, so that we can afford 7,000 more doctors and 4,000 more nurses across the whole NHS. That has made a huge difference to the statement we are making today.

The Secretary of State is right to say that abuse should never be tolerated, but does he not also accept that many of the problems in residential care for the elderly stem from a system that is trying to make profits out of the running of homes that are grossly underfunded because of the cuts his Government have imposed, and which, despite having some excellent staff who do their best, rely largely on untrained and underpaid staff? When is he going to tackle the real problems at the heart of the system, as well as announcing inspection regimes?

I do not accept that all profit-making organisations are going to deliver poor care. There are some excellent ones and some bad ones. Poor care is poor care wherever it exists. The hon. Lady is right to say that we need to value more the staff who work in residential care homes and domiciliary care services. They do a fantastic job that is often not well paid. The best thing we can do for them is to make sure that, where they are in an organisation that delivers poor care, we shout about it and talk about it, so that people find out about it and something gets done.

More nursing staff and a rigorous focus on care for the person, as well as an improved inspections regime, are very welcome, but does the Secretary of State agree that we also need to focus on sharing best practice and innovative approaches to care, such as those being pioneered at the Association for Dementia Studies at the university of Worcester?

We absolutely do need to do that. Dementia care is an area where there needs to be lots more work and innovation. There is huge variation and even some very caring places could try new ideas. There are some very interesting ideas about dementia care in Holland, too. I absolutely welcome that work.

Does the Secretary of State think that standards could be improved further by having minimum levels of staffing in care homes, and does he think that more can and should be done to improve pay and rewards for care workers?

We have recommended levels of staffing, but in the NHS we have decided not to have minimum levels of staffing. We were worried that that would be seen as a hurdle where, once achieved, nothing more would need to be done about staffing levels. The real issue about staffing levels and mandating numbers from the centre is that care needs change on a daily basis depending on how complex the needs are of the patients in a particular ward or home. That is why it is difficult to do it from the centre. We want to make sure that everywhere has the right numbers of staff. That is why I hope the hon. Gentleman welcomes the fact that we have so many more nurses.

Barking, Havering and Redbridge University Hospitals Trust is working really hard to get out of special measures. We have a new chief executive and a new chairman who are paying particular attention to the recruitment of nurses and improving the efficiency of the appointment system. Will my right hon. Friend join me in congratulating Barking, Havering and Redbridge Trust on improving the level of patient satisfaction by four points?

I am very happy to do that, and I pay tribute to the leadership of the trust. There is a new chief executive and, as I have said, I have met the chief nurse. It is a very large trust with two big hospital sites. There are some very big challenges to tackle, but they are making important progress, and, like my hon. Friend, I am keen to get them out of special measures as soon as we can.

Having read the Care Quality Commission annual report and met the CQC, and seen in the report that in Stoke-on-Trent more than 20% of care homes have not been fit for purpose for a period of more than three and four quarters, may I welcome the inspection regime of care homes? Training and enforcement will be important.

May I refer back to the comments made by the hon. Member for Stafford (Jeremy Lefroy) in respect of Mid Staffordshire Trust and Stafford hospital, and to previous meetings we have had with the Secretary of State, his colleague in the House of Lords and the Prime Minister and say that, between now and September, we need to know categorically from the Treasury whether the Government are going to fund in full what the University Hospital of North Staffordshire trust says it will cost to run the new configured hospital services across the whole of north Staffordshire? Only when that happens can the Government say that they have solved the issues relating to Mid Staffordshire.

I thank the hon. Lady for her support for the new special measures inspection regime for care homes. With respect to the merger of UHNS and Mid Staffs, we will make sure that the funding is available that is necessary for that merger to happen. Money is not the issue. The issue is doing what the TSA asked to be done quickly and in full, and making sure that we have the right leadership across both hospitals on a long-term sustainable basis. I do not think it is about money; it is about taking rapid action to make sure there are stable services and that there is continuity of care.

Will my right hon. Friend join me in congratulating the staff at George Eliot hospital on their hard work in the past year and on the excellent result they achieved in the CQC review? Does he acknowledge that we need to do more at George Eliot to keep that improvement going and agree that we have now built a very strong platform on which to build the future of George Eliot as an important district general hospital in my constituency?

I agree with my hon. Friend on both points. We have seen 31 more doctors there since special measures, 52 more nurses, a new acute medical admissions unit and better flow throughout the hospital, reducing the number of moves that patients make between wards during their stay, so lots has been done. When I did a stint in the A and E department at George Eliot, I was very well looked after by the nurses there, but they told me how bad the IT systems were—I think they said there were 16 different IT systems in the hospital—and how they were constantly filling out new forms. I therefore hope that the partnership with University Hospitals Birmingham, which has one of the best hospital IT systems in the country—a fantastic system, developed by the trust itself—will mean that George Eliot can move to having really good IT, so that nurses have more time with patients, which is what they want.

The Secretary of State spoke earlier about the need to value staff who work in residential homes. I presume he meant by that people who care for vulnerable, elderly and disabled people in their own homes as well. I completely agree with that, and he knows that we have discussed many times in the House issues such as the 15-minute time slots and the lack of reimbursement for the travel costs that people who care for elderly or disabled people have to bear. Does he agree, therefore, that unless we address issues such as the pay and conditions of staff, whether in residential homes or in people’s own homes, we will struggle to recruit and retain the very best staff, whom we desperately need to look after our vulnerable people?

I agree with the hon. Gentleman that we need to value staff who work in the social care sector much, much better. I think they do a fantastic and very difficult job for what is not high pay at all, so I recognise that issue. I also agree with his concern about 15-minute slots. I find it hard to believe that anyone can really do everything they need to when visiting someone who is frail or vulnerable in their own home in just a 15-minute slot. The new inspection regime will look at that and if it is unsatisfactory, it will say so.

I am very keen to accommodate the interest of colleagues who are still waiting to question the Secretary of State. I should just remind the House that we have quite a substantial load of business today, and I know that the main debate is very heavily subscribed, so if I am to accommodate all remaining colleagues, there is a premium upon brevity—a seminar in which I think can most appropriately be conducted by a member of the Procedure Committee. I call Mr David Nuttall.

The families of elderly people in care are often those best placed to spot the early warning signs of poor care. To what extent will reports from families be used to determine and prioritise where inspections take place?

Such reports will be used. Members of the public will be involved in the inspection regime and the way that care homes respond to complaints and concerns raised by families will be an important part of what the new chief inspector looks at.

We all hope that the special measures regime speeds up the improvements that are needed in Morecambe Bay hospitals, but does the Secretary of State accept that the turmoil that those hospitals have been in for years now will never properly end until the Government recognise that the trust simply cannot deliver services with the same level of funding, given the almost unique challenges of rural isolation, severe deprivation and health need in the area?

I thank the hon. Gentleman for the work he has done with James Titcombe on the tragedy that happened at Morecambe Bay. I think there are particular issues in that trust owing to the fact that it is on two sites that take a long time to travel between geographically. The point of the new regime is to ensure that those issues get surfaced and that Ministers and the system have to address them. I hope that that is what will happen.

We await the report from Sherwood Forest Hospitals Trust with interest. Improvements have been made there, certainly in staffing levels, with the number of nursing staff rising significantly since the hospital trust went into special measures. However, one of the impediments to change at the trust is the terrible legacy of the private finance initiative, which is taking up 15% to 20% of the trust’s annual budget—something like £45 million. Is there anything more we can do to assist trusts in special measures that have a crippling legacy of PFI?

That is certainly something we keep under constant review, because it is a particular issue in some trusts. I would like to pay tribute to the progress made in Sherwood Forest trust—and in Newark hospital, which I know my hon. Friend has campaigned for—and to mention that it has an excellent chief executive, who has done a very good job in challenging circumstances.

I would like to pay tribute to the staff team at Northern Lincolnshire and Goole Hospitals Trust for the progress they have made, which has resulted in the trust moving out of special measures, but there is still much more to do. How will the Secretary of State ensure that the funding challenges faced by the local health service do not get in the way of making the further progress that is necessary?

Good progress has indeed been there, including centralising stroke services in Scunthorpe. There are funding pressures everywhere. What I would say about funding is that I do not want to run away from the fact that money is tight throughout the NHS, but lots of places are delivering safe, compassionate care even with those funding constraints. In fact, when we look in detail, we see that less safe care is the most expensive, so what we are doing should help trusts such as the hon. Gentleman’s to deliver safer care.

May I reiterate my support for my right hon. Friend’s policy of putting patients at the centre of the NHS? Clearly I am disappointed that North Cumbria Trust continues to remain in special measures, particularly given the hard work of the staff and management there. However, will the Secretary of State assure me that if the trust, with the support of Northumbria, produces a robust action plan to address the issues that have been raised, a re-inspection by the CQC can happen sooner rather than later?

No one is keener than my hon. Friend and I to get the trust out of special measures as quickly as possible, and I thank him for the many representations he has made with respect to North Cumbria. I know that the trust is disappointed not to come out of special measures, but it is now rated good in terms of being caring, and the CQC said in July that the staff were supportive to patients and those close to them, so some encouraging things are happening at the trust, and we will do everything we can to help it to go the final furlong.

I very much welcome the progress that has been made at East Lancashire hospitals. Following action by the Secretary of State last year, the trust has now recruited more than 200 new nurses, nurse support staff and consultants. In March, a new state-of-the-art £9 million urgent care centre at Burnley was officially opened to the public, replacing the old A and E department, which was downgraded under Labour in 2007. Given that poor performance at the trust was established back in 2005 and that the last Government failed to act on it, how can we ensure that future problems are addressed speedily, rather than being hushed up?

I thank my hon. Friend for his interest in his local hospital and I agree with him that the trust has made good progress. There is a simple way to ensure that these things get acted on quickly and that is to make sure they are public. When things are public—when they are transparent and everyone knows about them—the NHS and Ministers have to act, and that is the purpose of this system.

Will my right hon. Friend confirm that if someone dies or is hurt in a residential care home, the directors of that home will also be held culpable under law?

With reference to University Hospitals of Morecambe Bay NHS Foundation Trust, which has just gone into special measures, may I reassure the Secretary of State that the CQC has seen some improvements there delivered by front-line staff, particularly at Royal Lancaster infirmary? However, I want to underline what the hon. Member for Barrow and Furness (John Woodcock) said about the unique geographical problems facing a trust with four hospitals separated by hundreds of miles of sea, mountains and valleys.

I absolutely recognise that issue, which is something we will have to think about in terms of the long-term sustainability of the trust. Let me reassure my hon. Friend and the hon. Member for Barrow and Furness that the CQC chief inspector will not say that a trust can come out of special measures unless he can see a long-term sustainable future for that trust, so part of the purpose of the regime is to force everyone in the system to confront those issues so that we bite the bullet quickly.

The positive progress of the Northern Lincolnshire and Goole NHS Foundation Trust is to be welcomed and is a direct result of the work of health care assistants, nurses and doctors. On the issue of social care, may I commend North Lincolnshire to the Secretary of State and ask him perhaps to visit again? The local council has not only refused the request by the Labour opposition on the council to cut social care in the budget, but has actually increased funding for elderly and disabled people by £1 million in this year’s budget and is opening up a network of well-being centres to support older people in their own homes, as well as constructing a £3.2 million intermediate care facility, so that a lot of our residents do not have to go into hospital in the first place.

I thank my hon. Friend for the warm welcome he gave me when I visited the trust—including the visit to a not particularly healthy, but delicious bakery as part of the trip. I welcome what is happening in social care, and I think it is something on which we can agree at the national level across the House—that cuts in social care can be very counter-productive, leading to more pressure on the social care system and more pressure on the NHS.