House of Commons
Wednesday 11 February 2015
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Minister for the Cabinet Office was asked—
Religious Organisations (Charitable Status)
1. What recent representations he has received on religious organisations and charitable status. (907553)
I have not received any representations recently from religious organisations on charitable status. More than 25,000 registered charities involve the promotion of religion. They play a hugely important role in our communities and support those in need. I pay tribute to their excellent work. They are often first in and last out of some of our toughest communities.
The Minister may recall the campaign that some of us waged on behalf of the Plymouth Brethren to retain its charitable status. It must have been for love, because they refused to vote on principle. We eventually won that campaign, but there is a worry on the part of many religious groups that increasingly so-called British values will trump faith values. Can the Minister assure faith groups that in the context of toleration for others they will be allowed to have space to teach their own faith?
My hon. Friend will know that the Charity Commission is independent of the Government and the Cabinet Office. It already respects the diversity of religious views, registering hundreds of new religious charities from a range of faiths every year, but it is fair to say that the Charity Commission did need to improve, as the National Audit Office said. It is now well on its way to doing that, but he can be assured that the Charity Commission has learned its lessons from the case he raises.
This is not about the Plymouth Brethren, but about a tiny sect of the Plymouth Brethren known as the Hales Exclusive Brethren. It is practising cruelty, I believe, in many ways against its own people. This is a dangerous sect. Rightly, the Charity Commission withdrew its status. The sect then had a campaign, which spent £2 million, to convince the Charity Commission that it had changed, and it changed its deeds. It is quite clear that this is what it calls “spoiling the Egyptians”, a process to deceive the Charity Commission. It is not abiding by its new status.
I thank the hon. Gentleman for that question, but the Charity Commission looked at this matter in detail and that religious group retained its status. Public benefit has always been a defining element of charitable status. That is what is unique about charities and what distinguishes them from private enterprises. We have no plans to change that.
Does my hon. Friend accept that British values have been forged in large measure by this nation’s Christian heritage? It is very important that our Christian heritage should be put at the forefront of our concerns. Will he make sure that the Charity Commission understands that there is widespread concern that Christian values are being treated on a par with other faiths, and that Christian values must be pre-eminent? There is a particular threat in our schools, where Ofsted is not taking the right view.
I completely understand what my hon. Friend says, but I have been assured that the Charity Commission has learned the lessons of the Brethren case. The commission is currently undergoing a major change programme to address the recommendations of the National Audit Office and become a more focused, robust and proactive regulator.
The case exhibited a deal of interest among the media, but the Brethren people went out of their way to ensure they provide a public good, in particular in schooling in my part of Northern Ireland and across the United Kingdom. Will the Minister maintain the stance that that public good far outweighs any perceived evil on the other side?
As I said, the key issue for the Brethren was to prove public benefit in what they were doing. That is the defining element of charity status, and the Charity Commission accepted that.
2. What progress he has made on implementing his Department's transparency agenda. (907554)
In January this year, the UK was ranked top of a list of 86 countries on the World Wide Web Foundation’s open data barometer for the second year running. In addition, last year the 2014 Global Open Data Index again ranked the UK No. 1 out of 97 countries. There are now 19,000 data sets published on data.gov.uk and our national information infrastructure sets the framework for how we manage hugely valuable open data.
I have a local issue to which I would like the Minister to respond. In Hull, 1,000 people applied for the first 14 jobs that Siemens recently advertised. Until 2013, MPs got constituency-based figures on the number of jobseekers going after each job vacancy. I would like to know why this was stopped under his Government. I have never had a clear explanation, and I do not think it is aiding transparency in this country.
That sounds like an issue for the Office for National Statistics, which, as the hon. Lady knows, is independent of Ministers, but I will ensure that this issue is looked at and that she gets a proper answer.
Another aspect of the transparency agenda is showing how taxpayers’ money is being spent. Does the Minister agree that that is the best way to safeguard against the massive waste and wild spending we have seen in the past and to avoid ballooning deficits and flat-lining public sector productivity in the future?
I am proud that the UK is now ranked as having the most transparent Government in the world. It undoubtedly has an effect in driving efficiency and savings. The ability to benchmark and compare spending in different parts of Government is a hugely powerful driver of efficiency and savings, and we intend to continue down that path.
Can we perhaps have a bit more transparency with respect to ministerial interests? This week, we saw Ministers hobnobbing at the black and white ball, although I noticed that the Paymaster General was sadly excluded from the Cabinet auction, and we saw new analysis showing that in the past 12 months Tory Ministers have made 168 ministerial visits to marginal Tory-held constituencies. In the interests of transparency, will the Minister now provide a full list of all ministerial visits and the reasons the locations were chosen, and will he publish the ministerial list of interests?
It sounds like the hon. Gentleman is getting a little concerned about the result of the upcoming election. The Government are disclosing more about what Ministers do than any Government have ever done before, and enormously more than the Government whom he supported before 2010.
Public Sector Mutuals
3. What his policy is on promoting the formation of public sector mutuals. (907555)
The Government are committed to supporting the growth of public service mutuals, which deliver benefits to front-line staff, commissioners and service users. There are now more than 100 live mutuals delivering well over £1.5 billion of public services, and more than 35,000 staff have themselves taken the decision to join a mutual.
I thank the Minister for his answer, but with the flagship mutual, Hinchingbrooke hospital, in special measures, will the Minister say whose idea it was to write to all the foundation and NHS trusts asking them to be pathfinder mutuals, and how many people have replied?
Mr Speaker, the
“failure of Circle at Hinchingbrooke hospital…where the company very nearly managed to remove an operating loss inherited from the public sector, was due to the failure of the NHS to deliver its side of the bargain”—
not my words, but the words of Tom Levitt, the former Labour MP for High Peak. Yes, a lot of NHS trusts have applied for the Department of Health and Cabinet Office mutual pathfinder programme, and all of that is progressing very satisfactorily. There are huge benefits for patients in this movement. We should all be concerned with that, not with an outworn, outdated ideology.
May I say how sad I was to hear that my right hon. Friend would be standing down at the next election? Singlehandedly, he has done more than anyone to reform the home civil service. What companies has he been in contact with to advise him on how public service mutuals might work better?
I am grateful for my hon. Friend’s kind remarks. This will be the second time I have left the House of Commons—the first time was not entirely consensual—and I shall be sorry to leave, although I think I have one more outing this time before the House dissolves.
Many businesses in the private sector operate as mutuals—John Lewis prominent among them—and they have been generous in their support for this programme because they think that employee ownership and control also benefit service users, which should be our overriding concern.
Government Digital Service
4. What assessment he has made of the effectiveness of the Government Digital Service. (907557)
The Washington Post hailed the UK as
“setting the gold standard of digital government”,
and the Obama Administration have created a digital service modelled on our own. The Australian Government announced the same in January this year. The New Zealand Government have taken the source code from gov.uk and used it for their own online presence. Last October, we celebrated the 1 billionth visit to gov.uk.
The Government Digital Service has been one of the unsung success stories of the Government, and it has been introduced smoothly and successfully. There have been none of the mess-ups that occurred on previous IT projects, which has meant that it has not had the public attention it deserves. What further services does the Minister foresee digitising to save taxpayers’ money and improve services for the public?
We have already saved a great deal of money and improved services for citizens, and we are beginning to roll out much better technology in government, so that civil servants are helped by the technology they have rather than hindered by it. There is much more to do. We inherited some extremely expensive, cumbersome and unwieldy IT contracts, and for one of them the Department had to pay £30,000 to change one word on a website. That is not acceptable; it is no way to treat taxpayers’ money; and it is going to change.
The Government Digital Service is a very talented group within the Cabinet Office and is internationally recognised, so it is unfortunate that the Minister has prevented the group from working with local government. On Monday, the Minister for Culture and the Digital Economy said that he agreed with me and Labour’s independent digital government review that this expertise should not be barred from working with local authorities. Will the Minister now concede that GDS should be allowed and encouraged to work more closely with councils, so that we have digital services that work for everyone—locally and nationally?
The hon. Lady is completely right to flag up the huge scope for improvement in online services in local government. GDS’s focus has had to be on central Government, but in the document on efficiency and reform that we published at the time of the autumn statement, we flagged up that we expect this to be available across the wider public sector. The focus for the time being has to be on finishing the job in central Government, but helping to build an equivalent to support local government is a very high priority for us.
5. What change there has been in the proportion of Government procurement made through small businesses and the voluntary sector since May 2010. (907558)
The central Government’s direct spend with small businesses increased from 6.5% in 2009-10 to 10.5% in 2012-13, and small and medium-sized enterprises have benefited from a further 9.4% of indirect spend through the supply chain in that same year. I shall be publishing figures for 2013-14 shortly. We have moved a long way towards our ambition and aspiration that a quarter of Government procurement should be with SMEs.
What steps have the Government taken to make public procurement simpler, especially for small and micro-businesses on the Isle of Wight?
I am delighted that my hon. Friend has raised this point about supporting businesses in the Isle of Wight; he has been a huge and doughty champion of businesses in his constituency. We have made public procurement more transparent and accessible. We have published tenders and contracts through the contracts finder website—and we shall be launching a much-improved version of that very soon. We have simplified how procurement takes place to take away some of the bureaucracy that looked like it was designed to stop small businesses competing for, and winning, business. There is much more we can and will do.
12. Reading through the UK Statistics Authority booklet, I am struck by the number of times that the Government have been rebuked for giving false information in their statements. The Prime Minister is twice rebuked for giving the wrong facts about the debt, saying that it is falling when it has in fact been rising. Could the Cabinet Office get together with the UK Statistics Authority and agree to deal with facts, rather than fiction, in Government statements for the next three months? (907566)
Order. The question is about Government procurement, small businesses and the voluntary sector.
I am sure that the hon. Gentleman made a very interesting point, but I am finding it hard to relate it to the question under consideration.
6. What system is used for identifying potential candidates for public appointments. (907559)
As was the case under the last Government, appointments to public bodies are made on merit by Ministers after a fair and open selection process regulated by the Commissioner for Public Appointments. We have taken unprecedented steps to open up the public appointments process to new talent, slimming down the application process, placing an emphasis on ability rather than prior experience, and increasing awareness. In the first six months of the current financial year, 44% of new public appointments made by Whitehall Departments were women, compared with about a third under the last Government.
The Minister knows that, following the fiasco of the Home Secretary’s attempt to appoint a chairman of the inquiry into child abuse allegations, there is a sense that there is a black book or a secret list, dominated by the metropolitan elite. They are all from London, they all know each other, and they all went to school together. When will the Government open up the secret list, and let us know how people get on it?
As I have said, we have moved significantly towards our aim of ensuring that 50% of public appointments are of women. I recently hosted events organised in Birmingham and Leeds to encourage people from outside London to express interest and apply for such roles, and I am delighted to say that there was a huge amount of interest. We will continue down that path. [Interruption.]
Order. A great many very noisy private conversations are taking place in the Chamber. We should have a bit of order, not least so that we can hear the Chair of the Public Administration Committee, Mr Bernard Jenkin.
Cross-Government Planning and Implementation
7. What plans he has to improve the effectiveness of his Department in co-ordinating planning and implementation across Government Departments. (907560)
That is a question on which the Public Administration Committee has focused for a long time, and very welcome it is too.
The creation of the implementation unit in the Cabinet Office has done a great deal to increase implementation capabilities throughout the Government, and I am glad to say that we have launched a series of other initiatives to bring Departments together. We have created the better care fund, the stabilisation unit, the international energy unit and the troubled families programme, and we intend to continue the process.
During the inquiry that we conducted on future challenges facing the machinery of Whitehall, we found that, so far, the Government have been very good at imposing departmental spending limits, but there is a capability deficit when it comes to cross-departmental financial planning and management. How do the Government propose to address that?
I agree that it needs to be tackled. I think that the most signal example is the relationship between local authorities—in particular, adult social care departments—and the health service. We are now focusing on that above all, and trying to prevent circumstances in which a failure to pool budgets leads to worse results for patients. I think that we shall then have a model that we will try to use in many other areas.
Does the Minister have any discussions with other Departments about the closure of offices? Offices are being closed in my constituency, and that would clearly not be happening if efficiency were the criterion. What co-ordination does the Minister apply to the closure of offices in the areas that need them most?
In recent years, my right hon. Friend the Minister for the Cabinet Office has had the unique distinction of having made public services more efficient by finding vast efficiency savings, which have amounted to some £20 billion a year in the current Parliament. Had the last Government followed such a lead, we might not have been in the dire situation in which we found ourselves in 2010, and the need for our long-term economic plan might not have been as great as it was.
T1. If he will make a statement on his departmental responsibilities. (907582)
My responsibilities are for efficiency and reform, civil service issues, public sector industrial relations strategy, Government transparency, civil contingencies, civil society and cyber-security.
Today’s National Audit Office report on late payment says that the Government’s policy to pay invoices more quickly risks boosting the working capital of the main contractors rather than benefiting small businesses down the supply chain. Why then did the Government on three separate occasions refuse to adopt amendments I tabled ensuring that small businesses all the way down the supply chain would have been paid on time?
We have gone infinitely further than any previous Government ever did to ensure that payment is speeded up through the creation of project bank accounts and inserting into main suppliers’ contract terms a requirement that they pay quickly as well, because the concern is a very real one. Small businesses can end up being starved of cash and it is not acceptable, so we are driving much better practice through these legal obligations. The situation is better than it was, but there is much more still to do.
T2. May I congratulate and thank my right hon. Friend on having secured a 4.3% increase in public service productivity in the first three years of his watch, by contrast with the zero growth over the previous 13 years? What further measures does he plan to take to increase public sector productivity? (907583)
I am grateful to my hon. Friend for his comments. There is much more to do. According to the Office for National Statistics, public sector productivity remained flat throughout the Labour years and it has started to increase, but there is much more that we need to do. We have said further savings and reductions in the cost of delivering public services can be made while the quality of the service increases. We have shown over this period that we can do more for less, but we are going to need to continue with redoubled effort in the future.
Given his laudable aims to improve access to Government contracts for small business, is the right hon. Gentleman as disappointed as I am about revelations in The Independent today that Capita faces allegations of using a major Government contract to short-change small companies, forcing many out of business? He described this contract as a model of how to open up the public sector, yet it has catastrophically failed. Given his championing of the Maude awards for failure, will this contract be a winner of such an award, and what lessons has he learned from this contract?
We have learned a lot of lessons from this contract, and I absolutely am as disappointed as the hon. Lady. It should not be working like this. I am aware of the concerns and we are investigating them very rapidly to get remedial action; it is not acceptable.
T3. The framework agreement for public procurement of infrastructure in the south-west provides that the bidder that gets closest to the average tender price, not the cheapest, gets the job. Will my right hon. Friend look into this matter, because it seems to me that this is wasting taxpayers’ money? (907584)
I am not familiar with the precise issue my hon. Friend raises, but it sounds very odd to me, and I will investigate it. Of course everyone who spends public money procuring services, goods or infrastructure needs to ensure the money is spent as well as it possibly can be, and I will look urgently at the case my hon. Friend raises.
T4. The Geoffrey Dickens dossier was distributed across the Central Office of Information in the early ’80s, with one special archive suddenly emerging. How can we be certain there is not another special archive in the Cabinet Office that needs to be handed over to the police immediately? (907585)
The Central Office of Information had nothing to do with any of this. That is a completely different, and now defunct, organisation. I am ensuring that officials in my Department are going through all the files thoroughly to make sure that they are organised, that they know what is in them, and that any files that are at all relevant are submitted immediately to all of the inquiries that are under way. There is no excuse whatsoever for these files not being surfaced.
T5. Will the Minister join me in praising the vibrant charity and social enterprise sector in west Norfolk for all its superb work, especially the two charities chosen by this year’s mayor, Barry Ayres, namely the Prince’s Trust of King’s Lynn and the west Norfolk Kandoo club? (907586)
Social enterprises and charities make an invaluable contribution to our economy and society, and I am delighted to join my hon. Friend in thanking those charities in Norfolk and others across the country for their work. We are investing about £470 million over the spending review period directly to support charities and voluntary groups.
T7. At Prime Minister’s questions in November last year, the Prime Minister said that “there are 1,000 more GPs across the country than there were in 2010.”—[Official Report, 5 November 2014; Vol. 587, c. 822.]According to the UK Statistics Authority, however, there were actually 356 fewer. That is just one error. The UKSA recently revealed that, since May 2010, it had had to investigate the Government more than 200 times for the use of dirty statistics. When will this Government stop their fiddling? (907588)
Order. We have got the gist of the hon. Gentleman’s question.
The hon. Gentleman should be aware that the UK Statistics Authority has on several occasions found the Opposition guilty of using statistics in a misleading way. That is its function: to hold us all accountable.
The Prime Minister was asked—
Q1. If he will list his official engagements for Wednesday 11 February. (907567)
This morning I had meetings with ministerial colleagues and others, and in addition to my duties in this House, I shall have further such meetings later today.
Does my right hon. Friend recall the general election of 1983? It resulted in a Conservative landslide win in which I and 100 other Conservatives were elected for the first time. At that time, unemployment stood at 3 million; today it is 2 million. The rate of inflation was 8%; it is now under 2%. The work force numbered 24 million; today it is 30 million. There were 9 million women in the work force in 1983; today there are 14 million. Does he agree that those comparisons, coupled with the trump card which he and Baroness Thatcher shared, in the form of a left-wing Opposition leader who has lost control of his own party, will put Britain on course for another Conservative landslide?
I am grateful to my hon. Friend. I was not a voter in 1983, but it is true to say that this Government are cutting unemployment and that every Labour Government always puts up unemployment. In my hon. Friend’s constituency, the claimant count has fallen by 55% since the last election. This also speaks to a bigger picture, which is that this Government have created 1,000 jobs for every day that we have been in office. We all remember the prediction from the leader of the Labour party that our plans would cost 1 million jobs. With unemployment tumbling, perhaps today is the day he should apologise.
An hour ago, we learned that linked to the HSBC tax avoidance scandal are seven Tory donors, including a former treasurer of the Tory party, who between them have given the party nearly £5 million. How can the Prime Minister explain the revolving door between Tory party HQ and the Swiss branch of HSBC?
I saw that list just before coming to Prime Minister’s questions. One of the people named is the Labour donor, Lord Paul, who funded Gordon Brown’s election campaign. I am very clear: people should pay their taxes in our country, and no Government have been tougher than this one in chasing down tax evasion and tax avoidance.
Let us talk about the difference between the Prime Minister and me. None of those people has given a penny on my watch, and he is up to his neck in this. Let us take Stanley Fink, who gave £3 million to the Conservative party. The Prime Minister actually appointed him as treasurer of the party and gave him a peerage for good measure. Will he now explain what steps he is going to take about the tax avoidance activities of Lord Fink?
I will tell the right hon. Gentleman about the difference between him and me. When people donate to the Conservative party, they do not pick the candidates, they do not choose the policies and they do not elect the leader. When the trade unions fund the Labour party, they pay for the candidates, they pay for the policies, and the only reason that the right hon. Gentleman is sitting there today is that a bunch of trade union leaders decided that he was more left wing than his brother.
The Prime Minister cannot get away from it: he is a dodgy Prime Minister surrounded by dodgy donors. He did not just take the money—[Interruption.]
Order. It has always to be said: the questions will be heard and the answers will be heard, because this is a democratic Chamber. I do not mind how long it takes, they will be heard.
He did not just take the money; he appointed the man who was head of HSBC as a Minister. It was in the public domain in September 2010 that HSBC was enabling tax avoidance on an industrial scale. Are we seriously expected to believe that when he made Stephen Green a Minister four months later, he had no idea about these allegations?
I am glad the right hon. Gentleman has brought up the issue of Stephen Green, who was a trade Minister in this Government. This is the same Stephen Green whom Gordon Brown appointed as the head of his business advisory council. This is the same Stephen Green whom Labour welcomed as a trade Minister into the Government. It is the same Stephen Green whom the shadow Business Secretary, who is looking a bit coy today, invited on a trade mission as late as 2013. We know what happens: every week the right hon. Gentleman gets more desperate. He cannot talk about the economy and he cannot talk about unemployment, and so he comes here with fiction after fiction. Let me deal, while I have a moment, with the fiction we had last week. He came here and, if you remember, he talked about something called intermediary tax relief. It turns out—[Interruption.] We have as long as it takes.
Order. I said that the questions must be heard. The responses must be heard.
Thank you, Mr Speaker. Last week, the Labour leader asked me six times about the tax treatment of hedge funds. Now it turns out that the treatment he is complaining about was introduced in the autumn of 1997 by a Labour Government. It further turns out that it was extended in 2007. Who was in power in 2007? It was Labour. Who was the City Minister in 2007? I think we’ll find it was Ed somebody.
I know the Prime Minister does not care about tax avoidance, but on this day of all days he is going to be held accountable for answering the question. He is pleading ignorance as to what was happening with Stephen Green, but today we discover that the Minister in charge issued a press release in November 2011 which referred to the investigation into the HSBC Geneva account holders. Does the Prime Minister expect us to believe that in Stephen Green’s three years as a Minister he never had a conversation with him about what was happening at HSBC?
Why did Labour welcome Stephen Green as a trade Minister? Why were they still booking meetings with him in 2013? My responsibility is the tax laws of this country, and no one has been tougher. Let me remind the right hon. Gentleman about what we found: hedge funds cutting their taxes by flipping currencies—allowed under Labour, banned under the Tories; foreigners not paying stamp duty—allowed under Labour, banned under the Tories; and banks not paying tax on all their profits—allowed under Labour, banned by the Tories. Those two in the Treasury were the friends of the tax dodger. We are the friend of the hard working tax payer.
The Prime Minister is bang to rights, just like his donors. And doesn’t this all sound familiar? The Prime Minister appoints someone to a senior job in government. There are public allegations but he does not ask the questions, he turns a blind eye. Isn’t this just the behaviour we saw with Andy Coulson?
It is desperate stuff. The Opposition cannot talk about the economy because it is growing; they cannot talk about unemployment because it is falling; and they cannot talk about their health policy because it is collapsing. What have we seen this week? They cannot even go in front of a business audience because they have offended every business in the country; they cannot go to Scotland because they are toxic; they cannot talk to women because they have a pink bus touring the country; and they have even offended Britain’s nuns. No wonder people look at Labour and say that it has not got a prayer.
He took the money, gave a job to the head of HSBC, and lets the tax avoiders get away with it. There is something rotten at the heart of the Conservative party and it is him.
For 13 years, Labour sat in the Treasury and did nothing about tax transparency, nothing about tax dodging, and nothing about tax avoidance. This Government have been tougher than any previous Government. That is why the Opposition are desperate and that is why they are losing.
At the weekend, graduates of Bournemouth university and the Arts university, Bournemouth, enjoyed yet another year of success at the BAFTAs. Last week, Bournemouth was named as having the fastest growing digital economy in the United Kingdom. Does my right hon. Friend agree that Britain remains a world leader in the creative industries because of the talent of our people combined with our long-term economic plan?
My hon. Friend is absolutely right. Our creative industries are a vital part of our economy and our country. When we look at the great results at the BAFTAs and the high hopes that we have for the Oscars, it is clear that British television and British film are conquering the world. Bournemouth university plays a very important part in that, because its training of some of our digital effects specialists and of many of our creative people is a key part of this vital and growing industry.
Q2. Last week at Prime Minister’s questions, I warned the Prime Minister about falling wages. This week, he said that Britain needs a pay rise, so I am glad to see that he is waking up to reality. Does he now agree with me that the people who most need that pay rise are the families who have lost £1,600 a year under this Government, and not those at the top to whom he has given massive tax cuts? (907568)
The hon. Lady will find that the wages in the public and private sectors are growing ahead of inflation, which is good. As we have raised to £10,000 the amount of money people can earn before they start paying taxes, they are better off. In Scotland, there are 175,000 more people in work today than when I became Prime Minister. As a result of growth in the jobs market, growth in wages, cuts in taxes, and an increase in the minimum wage, things are getting better for families in Scotland.
For years, the supermarket chain Aldi has been sitting on an empty supermarket that it acquired in the centre of Eston in my constituency. Does the Prime Minister agree that the supermarket chain should be forced to release assets that it does not need rather than allow them to be a blight on the community?
What we need to see is successful development going ahead and brownfield sites being used. If those sites cannot be used for retail, they should be made available for other uses. One change we have made is to liberalise the use classes in planning so that we do not have the long-term planning blight of development not going ahead in towns and cities where houses, jobs and investment are needed.
Q3. Given the Prime Minister’s new-found concern that employers should give their staff decent pay rises, can he explain why he did not apply that principle to his own Government when they decided not to implement the recommended 1% pay increase for NHS staff? (907569)
What we have done with NHS staff is ensure that the lowest paid are getting a pay rise. In the NHS, there is progression pay, so everyone will get at least a 1% rise, but many people, because of progression, will get a 2%, 3% or 4% pay rise. Alongside that pay rise, they will be paying less in tax, council tax in many areas has been frozen, and diesel and petrol prices are coming down. People’s standards of living are rising because we have a long-term economic plan and we are sticking to it.
Q4. More than ever before, businesses, students and commuters in Hampshire use the trains to get around, but they are increasingly frustrated that our trains are stuck in the analogue age. Access to the internet can be really difficult and very limited. Will my right hon. Friend consider that important issue and see what the Government can do to help commuters and others get access to wi-fi on our trains?
My right hon. Friend is absolutely right to raise this. It is vital for businesses and for individuals to be able to access wi-fi, do their work and make other contacts while they are on trains. I am pleased to announce plans that will see the roll-out of free wi-fi on trains across the United Kingdom from 2017. The Government will invest nearly £50 million to ensure that rail passengers, who make more than 500 million journeys every year, are better connected, with the four rail operators—Thameslink, Southern and Great Northern; Southeastern; Chiltern; and Arriva Trains Wales—all benefiting from that investment.
The Motability car that my severely disabled constituent, Mark Francis, has had for 11 years is being taken from him in two weeks. Born with hereditary spastic paraplegia and unable to walk without crutches or sticks, he is sadly deteriorating by the week. I have been told that his case will be reconsidered, yet the Department for Work and Pensions is punitively and callously snatching his car from him on 25 February. Will the Prime Minister immediately rectify that heartless and disgraceful injustice?
As ever, I am very happy to look at the individual case raised by the right hon. Gentleman. Of course, with the replacement of disability living allowance by the personal independence payment, the most disabled people will be getting more money and more assistance, rather than less, but as I say, I will happily look at the case.
Q5. Given the widespread cynicism about politicians’ promises and claims, will my right hon. Friend remind people, however long it takes, that this Government have presided over the creation of more than 2 million additional private sector jobs, which is far, far more than we ever promised? Does not that discredit the claims of the Opposition that our efforts to cut the deficit would destroy jobs? (907571)
My right hon. Friend is absolutely right. The figures are clear: we have created 2 million additional private sector jobs, and if we look at the number of extra people in work, public and private sector combined, it is 1.75 million more people. Behind those statistics are families who now have a pay packet and a job, and the chance to have a more secure future, and all that at a time when the Leader of the Opposition was very clear: he warned that our policies would cost 1 million jobs. He was 1 million per cent. wrong, and it is time that the Opposition withdrew what they said and apologised for all those statements.
In November 2012, Her Majesty’s Revenue and Customs, in evidence to the Public Accounts Committee, said that there were a dozen prosecutions in train in relation to the HSBC case load. None of them have come to court yet. Can the Prime Minister explain why?
First, on prosecutions for tax evasion, the figures are that they have gone up fivefold under this Government since 2010—2,650 cases, leading to hundreds of years of imprisonment, taken as a whole. That is what has happened, but there is an important point here, which is that, in our country, the tax collection agency, HMRC, is independent of Government and independent of Ministers, and it has to raise the taxes, carry out the investigations and order the prosecutions. It is very important in a free country that Ministers are not given the details of who is being investigated and what the prosecutions are. This does not happen in other countries, and we have a word for that: it is called corruption, but it seems to be the path suggested by the Labour party.
Q6. My constituents—[Interruption.] (907572)
Order. The hon. Gentleman is entitled to be heard with courtesy.
Thank you, Mr Speaker. My constituents in Montgomeryshire are not able to see a GP as quickly as they should. Does the Prime Minister agree that we need to train more GPs to take forward our plans for surgeries to be open seven days a week and in the evenings, and will he press for similar hours of opening to be available to my constituents in Wales?
I will certainly press for that change, because we now have 1,000 more GPs operating in England, and we have made the commitment that we are going to have seven-day opening, from 8 in the morning until 8 in the evening. That is already available now to some 4 million people. We are going to spread that across the country. I would urge the NHS in Wales, even at this late stage—and, more to the point, the Labour Government in Wales, because their decision to cut the NHS has landed the NHS in Wales with those difficulties—to reverse that policy and look at how we can expand access to GPs in Wales, because that is the right policy.
On Monday, the launch of the second major report of the all-party parliamentary group against anti-Semitism was attended by the Archbishop of Canterbury, Mr Speaker and others. Will the Prime Minister meet a group from that committee, because although the report is a work plan for the next Parliament, the issue of the security of synagogues and other Jewish communal buildings is too urgent to wait until May?
First, I commend the hon. Gentleman for the work that he does in fighting anti-Semitism. I know that he takes a very prominent role, both inside and outside the House, with the work that he does. It is vital to reassure Jewish communities at this time, particularly after the heightened tensions because of what happened in Paris and other issues. I have met with the Jewish Leadership Council; I regularly discuss the issues with it. We make support available, and I have made sure that the police have contacted all the relevant organisations to try and work with them, but I am very happy, as ever, to sit down with Members of Parliament and hear their views, too.
Q7. Local enterprise partnerships covering Harrogate district have awarded 14 grants from the business growth fund totalling over £1.7 million. This has led to the creation of 158 jobs, many in manufacturing—part of the 60% fall in unemployment that we have seen locally. Will the Prime Minister commit to further investment in northern manufacturing, as it is key to rebalancing our economy? (907573)
I am very glad that my hon. Friend sees a manufacturing revival taking place in Britain. We have seen manufacturing investment and manufacturing output increase. That is happening in all the regions of our country, which is worth while. We will be playing our part by investing £10 million in the development of the Advanced Manufacturing Research Centre in south Yorkshire. These and other catapults can make a real difference by backing the revival of manufacturing in our country.
As I remarked earlier, I have been reading the report of the Statistics Authority. The fact is that the Labour Government prosecuted more companies for corporate tax evasion than this Government have done. It is a major scandal in this country that many, many people who make money from our consumers do not pay their tax in this country. What is the Prime Minister doing to plug these gaps?
When we chaired the G8, we put at the head of the agenda the issue of tax transparency, tax evasion and aggressive tax avoidance, and we now have 90 countries automatically sharing their tax information, including Switzerland, so the events that we are discussing—events and allegations of crimes—all took place when Labour was in power. Were this to happen again, we would not have this situation, because we have the automatic transparent exchange of tax information, something that this Government put on the agenda. Labour started talking about it only after we did that.
Q8. According to a recent survey of 40,000 patients carried out by the Care Quality Commission, the accident and emergency service at our county hospital in Dorchester is the No. 1 in the country. Will my right hon. Friend praise all the staff who work there, and reassure the hospital that as it prepares to integrate its services for south, west and north Dorset, the money will follow that good work? (907574)
I certainly join my hon. Friend in congratulating the Dorset County Hospital NHS Foundation Trust. Its work shows what can be done when we better integrate health and social care, and also when we look at how we can treat frail elderly people in the community, often people who have more than one difficult condition that needs treatment. What is best for them is often not A and E, but treating them in community hospitals, looking after their ailments and helping them to do better at home. That is what we should be focused on, and that is Simon Stevens’ plan for the NHS; we have already come up with the money to get the plan well under way.
Q9. Did the Prime Minister have conversations with Lord Green about tax avoidance at HSBC—[Interruption.] (907575)
Order. I said a moment ago that the hon. Member for Montgomeryshire (Glyn Davies) had a right to be heard with courtesy. The hon. Lady has a similar right to be heard with courtesy, and be in no doubt: she will be heard with courtesy.
Thank you, Mr Speaker. I just wanted to know whether the Prime Minister has had any conversations with Lord Green about tax avoidance at HSBC; if not, why not?
When I appointed Stephen Green, every proper process was followed. I consulted the Cabinet Secretary and the director for propriety and ethics, and of course the House of Lords Appointments Commission now looks at an individual’s tax affairs before giving them a peerage. I made the appointment, it was welcomed by Labour, and three years later, it was still holding meetings with him.
Q10. Jordan Bates is a mother of two from Redditch who works hard to give her children the best start in life. What does my right hon. Friend think she needs: measures to reward those who work hard, get on and do the right thing; or cheap, patronising, pink stunts? (907576)
I think that what Britain’s families need most to help them get on is the security of a good school place, which we are providing, the security of a good job, which we are providing, and the security of a safe community, which we are providing. On Labour’s campaign, I would say that the wheels are falling off the wagon, but I think that they are falling off the bus. We now know that it is not going to be driven by anyone on the Front Bench. Surprise, surprise, it is going to be driven by Unite.
Q11. The Prime Minister may have been briefed that the Care Quality Commission yesterday published its report on Hillingdon hospital, my local hospital. It found that we have an extremely dedicated, hard-working and professional team of staff, but patient safety is being put at risk by critical staff shortages and by the fabric of the building, which one of the report’s consultees described as being like something from the third world. Will the Prime Minister meet me and my parliamentary colleagues in Hillingdon to look at how we can secure the funds to make our constituents safe? (907577)
The CQC’s findings are clearly disappointing, but the trust seems to be taking immediate steps to address the issues that have been identified: raising standards for infection control and cleanliness; enhanced and more frequent training; and recruiting more permanent staff. I think that this relates to a bigger point, which is that for years in our NHS, when there was a problem with a hospital, it was swept under the carpet, rather than the hospital being properly examined, inspected and, if necessary, put into special measures and then corrected. That is what is happening now in our health service, and that is all to the good. It is important to say that on the day Sir Robert Francis published his report on how important it is to listen to whistleblowers in the NHS. Unlike the Labour party, we are determined to listen to the Francis report and to whistleblowers. I will certainly ensure that the Health Secretary meets the hon. Gentleman, his parliamentary colleagues and others in Hillingdon to make sure that the hospital gets the attention it deserves.
May I put it to the Prime Minister that from President Monroe onwards it has been generally acknowledged by leaders of great powers that, for the avoidance of war, it is often wise to acknowledge the concept of traditional spheres of authority and power; and that although Ukraine is of absolutely no significant strategic importance to Britain, Greece most certainly is; and that unless western statesmen show rather greater skills than they have in recent years, Greece will pass into the Russian sphere of influence without a shot being fired?
It is difficult to answer the Father of the House without a long, historical exegesis, but I would argue that, when it comes to Ukraine, it does matter on our continent of Europe that we do not reward aggression and brutality with appeasement; that would be wrong. That is why it is right to have the sanctions in place, right to keep the European Union and America together on the issue, and right to stand up to President Putin. On Greece, of course there is a British interest, which is that we want stability and growth on the continent of Europe. The eurozone crisis has held that growth and stability back; we want those concerned to come to a reasonable agreement so that Europe can move forward. It is good that the British economy is growing and jobs are being generated, but we have to recognise that our largest market at the moment is still relatively stagnant, and the situation in Greece does not help that.
Q12. There are adverts in Newcastle exhorting my constituents to report benefit fraudsters. May I ask the Prime Minister why he does not feel as strongly about tax avoidance? Will he report whether he had a conversation with Lord Green about tax avoidance? (907578)
I do feel strongly about tax evasion and aggressive tax avoidance. Let me tell you, when it comes to income tax, some of the things people used to get away with. Under Labour, people avoided paying tax by calling their salary from their company a loan: allowed under Labour, banned under the Tories. Businesses could avoid paying tax by paying employees through trusts: allowed by Labour, banned by the Tories. Time and time again, it is this Government who have come along and cracked down on tax evasion.
Q13. I am a proud Yorkshireman, and when I come to London I am proud that the glass pods on the London Eye are made by Novaglaze in Lockwood, in my patch, proud that the red carpet used for the royal wedding at Westminster abbey was made in Huddersfield, and proud that the upholstery in Boris’s Routemaster buses was made in Meltham in my patch. I wonder if they do upholstery for pink vans, by the way. There was more good news last week, with £2.9 million— (907579)
Order. One sentence. This is a question, not a statement.
Yes, Mr Speaker; I will finish very shortly. Tomorrow I am meeting local manufacturers at the award-winning Huddersfield university. Can I tell them that the Prime Minister will continue to put Yorkshire at the heart of his long-term economic plan?
I am afraid, Mr Speaker, that the truth is that you cannot fit all the good things happening in Yorkshire into one question; it is impossible. My hon. Friend could have added the medals won at the Olympics, or he could have talked about the cricket team—there is no end of things. The point is that the long-term economic plan that we have announced for Yorkshire and northern Lincolnshire sets out plans for transport investment, investment in science, helping universities, and getting behind the industries that are growing the fastest. That is what another Conservative Government would do: success for Yorkshire, security for families in Yorkshire.
Q14. Can the Prime Minister confirm that between May 2010 and December 2013 he never once had a conversation with Stephen Green about allegations of tax avoidance by UK-based HSBC clients? (907580)
We followed every procedure that one should, and this appointment was welcomed by the Labour party. More to the point, between 2010 and 2014 we passed law after law cracking down on tax evasion and cracking down on aggressive tax avoidance, and saw more prosecutions—all the things that Labour failed to do over and over again.
Sixth-form colleges such as Hills Road and Long Road in Cambridge do an excellent job in educating our young people, but they struggle to get by because, unlike school or academy sixth forms, they have to pay VAT of over £300,000 each. Will the Prime Minister listen to voices across this House and scrap this tax on learning?
I will look very carefully at what the hon. Gentleman says. I know it is important that we try to treat educational institutions fairly, and we all want to see the continued and growing success of our schools and colleges.
New Magna Carta
Q15. If he will commission a new Magna Carta to renew democracy in the UK as part of the celebrations of the 800th anniversary of Magna Carta; and if he will make a statement. (907581)
We should be proud that in Magna Carta our country established rules of justice and freedom that, 800 years later, still inform our constitution and resonate around the world. While there is a long-standing debate over the issue, there are no plans at present for a written constitution.
I note that the Prime Minister says “at present”. Does he agree, though, that there are unacceptably high levels of voter disengagement, with more people staying at home than voted Labour and Conservative at the last election? Would he commit his Government, now, to preparing an all-party constitutional convention, in order to give every UK citizen a copy of our society’s rulebook—either a statute of the Union or a written constitution—as a part of electors feeling once again that they own our democracy?
Obviously, I always look at the hon. Gentleman’s suggestions very carefully, because he has made a number of sensible cross-party interventions over recent years, but I have my doubts as to whether another talking convention is the answer. I think we need to look at some of the constitutional issues that leave people feeling left behind, not least English votes for English laws, and make sure that we put those things in place. The disappointment I have with the Labour party is that it is prepared to talk about all-party talks on Wales, Scotland or Northern Ireland, but when it comes to empowering English people and making sure that they have rights in this House, it is completely absent from the debate.
Article 39 of Magna Carta contains the origins of our right to trial by jury. In a recent report, Sir Brian Leveson, not satisfied with undermining the right to a free press, wants to restrict the right to trial by jury. Will my right hon. Friend, as long as he is Prime Minister, defend our historic rights?
I am a great supporter of jury trial. I think it is one of the very important things we have in this country that safeguard people’s rights and freedoms, and I do not want to see it reduced.
Francis Report: Update and Response
With your permission, Mr Speaker, I would like to make a statement on the Government’s response to today’s report on NHS whistleblowing by Sir Robert Francis, and on progress to date in implementing previous recommendations from his public inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.
I asked Sir Robert to carry out a follow-up review because of my concerns that, despite good progress in implementing his original recommendations, the NHS was still not making fast enough progress in creating an open and transparent culture in which staff feel supported to speak out on worries about patient care. As a result, I was concerned that changes are still necessary if the NHS is to protect patients properly by adopting a transparent, no-blame, learning culture as is common in other sectors such as the nuclear, oil or airline industries.
Sir Robert has confirmed the need for further change in his report today. He said he heard again and again of horrific stories of people’s lives being destroyed—people losing their jobs, being financially ruined, being brought to the brink of suicide and with family lives shattered—because they had tried to do the right thing for patients. Eminent and respected clinicians had their reputations maligned. There are stories of fear, bullying, ostracisation and marginalisation, as well as psychological and physical harm. There are reports of a culture of “delay, defend and deny”, with “prolonged rants” directed at people branded “snitches, troublemakers and backstabbers”, who were then blacklisted from future employment in the NHS as the system closed ranks.
We of course recognise the high standards of care day in, day out in much of the NHS, and we know that many staff feel supported in raising concerns about patient care, with many dedicated managers going out of their way to address those concerns. However, the whole House will be profoundly shocked at the nature and extent of what has been revealed today. The only way we will build an NHS with the highest standards is if the doctors and nurses who have given their lives to patient care always feel listened to when they speak out about patient care. The message must go out today that we are calling time on bullying, intimidation and victimisation, which have no place in our NHS.
Before outlining the Government’s response to today’s report, I want to update the House on the progress made in implementing previous Francis recommendations. I have today laid in the House of Commons Library a report showing progress on all 290 recommendations originally made by Sir Robert, as well as the progress made in implementing other recommendations by Professor Don Berwick on safety, by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart in their complaints review, by Camilla Cavendish in her work on health care assistants and by the NHS Confederation on reducing bureaucratic burdens. The progress was recognised this morning by Sir Robert, who said that the priority that must be given to safety, compassion and quality of care is now better recognised and acted on.
I want to highlight the impact of Professor Sir Bruce Keogh’s review of hospitals with high mortality rates. The special measures regime that followed introduced the toughest and most transparent hospital turnaround regime anywhere in the world, with 19 hospitals—more than 10% of NHS acute trusts—having been put into special measures so far. Among the vast array of improvements since the start of the process, those trusts have recruited 109 additional doctors and 1,805 additional nurses, and have made 129 board-level changes. The independent research company Dr Foster estimated this week that excess deaths in those trusts had fallen by 450 in less than a year. That means that between them, they may have saved as many lives as some estimated were tragically lost at Mid Staffs between 2005 and 2009.
We have moved from a system that tolerated or denied high mortality to one that, while it is by no means perfect, seeks out problems, shares them with the public, takes action and saves lives. Today I can announce that the Care Quality Commission, Monitor and the NHS Trust Development Authority have published a new memorandum of understanding to enshrine and further improve the special measures process.
The other measures that we have introduced include giving the CQC, under its new leadership, legal independence and the legal powers that it needs for its chief inspectors to root out failure and highlight excellence. The chief inspector of hospitals has inspected more than half of acute trusts and will have inspected them all by the end of the year.
We have introduced criminal sanctions for those who wilfully neglect patients and those who provide false or misleading information. The new duty of candour for institutions and professionals means that when mistakes are made, patients or their families must be told. Fundamental standards are now in place to ensure that all providers are required to treat people with dignity and respect. All acute hospitals are now asking patients if they would recommend the care that they receive to friends or members of their family. That is being rolled out to other parts of the NHS, including primary care. Two thirds of hospitals are now implementing the “name above the bed” initiative to ensure that hospital care is better joined up. More than 200 organisations have joined the “sign up to safety” campaign, which involves a commitment to halve avoidable harm and save 6,000 lives by 2017.
The entire NHS is now committed to patient-centred culture change as a key part of the “Five Year Forward View” plans that were put forward by NHS England last autumn. In that plan, we recognise the important point that safe care and efficient use of resources go hand in hand: doing the right things first time in health care saves lives and money.
In respect of whistleblowing, the Government have taken significant steps to protect NHS staff, such as enshrining the right to speak up in staff contracts, amending the NHS constitution, issuing joint guidance with employers and trade unions, extending the national helpline to social care staff, and changing the law to make employers responsible if whistleblowers are harassed or bullied by fellow employees.
Today, Sir Robert makes it clear that there is more to do, and I am extremely grateful to him and his team for their work. He sets out 20 principles and a programme of action. I confirm today that I accept all his recommendations in principle and will consult on a package of measures to implement them.
The recommendations include asking every NHS organisation to identify one member of staff to whom other members of staff can speak if they have concerns that they are not being listened to. Drawing on the inspirational work of Mid Staffs whistleblower Helene Donnelly, those “freedom to speak up” guardians will report directly to trust chief executives on the progress in stamping out the culture of bullying and intimidation that Sir Robert today says is still too common. We will consult on establishing a new independent national whistleblowing guardian as a full-time post within the CQC to review the processes that have been followed in the most serious cases where concerns have been raised about the treatment of whistleblowers.
Because too often the system has closed ranks against whistleblowers, making it impossible for them to find another job, I can announce today that the Government will legislate to protect whistleblowers who are applying for NHS jobs from discrimination by prospective employers. With Opposition support, those necessary regulation-making powers could be on the statute book in this Parliament.
We will provide practical help through Monitor, the NHS Trust Development Authority and NHS England to help whistleblowers find alternative employment. Those three bodies have agreed a compact for action on this issue, and will publish detailed arrangements later this year. We will ensure that every member of staff, NHS manager and NHS leader has proper training on how to raise concerns and how to treat people who raise concerns. As a vital last resort, the right of whistleblowers to contact the press with any concerns they have must always be safeguarded, although it should not have to come to that. Today I will write to every trust chair to underline the importance of a culture where front-line staff feel able to speak up about concerns without fear of repercussions. In addition, Monitor and the TDA will write to trust chief executives today to ask them to ensure that all managers discuss these issues as a matter of urgency with those who report to them.
There must be consequences for trusts that fail to develop a culture of openness, so today I am publishing consultation options to ensure that where hospitals are found to have knowingly withheld information from patients, the NHS Litigation Authority can impose financial sanctions such as reducing the indemnity it offers against litigation awards. The final decision on how we implement these recommendations will be made after proper consultation with NHS providers, whistleblowers and patient groups to ensure that we honour the spirit of what Sir Robert has recommended, and to avoid unnecessary layers of bureaucracy or financial burden. There is no reason for individual trusts not to get on with implementing Sir Robert’s recommendations right away, particularly in ensuring that staff have an independent person with whom they can raise concerns.
A further foundation of a safe and open culture is one where the NHS and the public have access to meaningful and comparable information about the performance of local NHS organisations. The new MyNHS website has already kick-started a transparency revolution by making the NHS in England the first health care system in the world to offer key, up-to-date safety information on every major hospital, including open and honest reporting, nurse staffing levels in every ward, and the number of falls and hospital-acquired infections. Some estimate that we have as many as 1,000 avoidable deaths in the NHS every month, so by the end of March 2016 the NHS will become the first health care system in the world to publish an annual estimate of avoidable deaths by hospital trust, based on case note reviews and the safety record of those trusts.
I will strengthen the accountability of trusts by asking the chair of every trust to write a letter to the Secretary of State by the end of May each year, outlining what measures they will be taking to reduce the number of avoidable deaths in their trust. In all cases we will make it clear that this is not a process of naming and shaming but one of learning and improving so that our NHS becomes the first health care system in the world to adopt system-wide the safety standards that would be considered normal in other industries. We must also better understand avoidable mortality outside hospital settings, and whether we can adapt the methodology to identify avoidable harm as well as avoidable death. I therefore announce today that the Department will fund a national study to establish the extent of avoidable death in community settings, and the feasibility of developing locally attributable death rates.
We will be taking steps to hard-wire transparency into the health and care system, and I am publishing a transparency architecture with plans for further information to be released on MyNHS. That will include comprehensive reporting on the friends and family test, data on residential care home admissions, and a new balanced scorecard on the work of CCGs and health and wellbeing boards. The Care Quality Commission and the National Information Board have confirmed to me that, starting this year, they will report annually and in public to the Secretary of State and the Health Select Committee on the progress of the transparency architecture, and on any recommendations about how we can improve it. The Secretary of State will report to Parliament annually on progress, and today I am publishing for consultation changes that will enshrine that right in the NHS constitution.
One of the biggest causes of poor care is when no one takes responsibility for a vulnerable patient and the buck is passed. That leads to greater costs and numerous personal tragedies as people are passed unnecessarily around the system. The “name above the bed” initiative has strengthened accountability in hospitals, as has bringing back named GPs outside hospitals, but there is still not enough clarity on the role of professionally accountable clinicians, particularly in community settings. Today I can therefore announce that the Academy of Medical Royal Colleges has agreed to develop guidelines for meaningful clinical accountability outside hospitals. It will publish its findings this spring, and before the end of the next financial year all CCGs will publish how many of their patients with long-term conditions are being looked after by clinically accountable community clinicians in the meaningful way the academy will define. Proper proactive care for our most vulnerable patients will not only reduce hospital costs but reduce avoidable harm and improve the quality of compassionate care.
We can fund the NHS with a strong economy, we can put in place new models of integrated care to support an ageing population and we can champion innovation, but if we do not get the culture in the NHS right, we shall never deliver the ambitions that everyone in this House has for our NHS. Today is about tackling that culture challenge head-on so that we build an NHS that supports staff to deliver the highest standards of safe and compassionate care and that avoids the mistakes that have led to both unacceptable waste and unspeakable tragedy. If we succeed, we will be the first country anywhere to put its entire health care system firmly on the path to eliminating avoidable harm and death. Our NHS deserves no lesser ambition, so I commend this statement to the House.
I welcome the Secretary of State’s statement and his obvious commitment to improve the culture of tackling poor care in the NHS; there is plenty of common ground between us. We endorse the principles laid out in Sir Robert Francis’s new report and we will work with the Secretary of State to get new safeguards on the statute book in the remainder of this Parliament, as he requested.
It was the Labour Government who, in 1998, introduced the first legal protection for whistleblowers in the Public Interest Disclosure Act 1998, reinforced in the NHS constitution in 2008. Sir Robert’s new principles build on those foundations. We thank him and the review team for their work and praise every whistleblower who has had the courage to come forward.
Our shared aim must be to create a climate in which every NHS worker feels able to raise concerns and feels confident that they will be listened to, that appropriate action will be taken and that they will not face mistreatment as a result. Sir Robert’s report will help achieve that. We particularly welcome the call for whistleblowers worried about losing their jobs to be offered alternative employment and for training in whistleblowing for all staff. Those measures are overdue. Will the Secretary of State say more about how Sir Robert’s principles will be enforced across the NHS and about the timetable for implementation? Will he confirm that they will apply equally to all providers of NHS services, including voluntary and private providers?
That brings me to an issue of major substance not covered in Sir Robert’s report. As he points out, his remit did not apply to any form of social care. That is a major concern, given that it could be argued that some of the poorest care provided in England today is in social care settings or in people’s own homes. Only at the weekend, a BBC investigation found that one in five care homes for older people is failing to meet standards for safety. Should we not today, across this House, establish the firm principle that Sir Robert’s recommendations should apply equally to all places where people receive care?
Let me turn to the recommendation for an external organisation that staff can approach for advice and support. In response to the first Francis report in February 2010, I established an expert group to update whistleblowing guidance. It reported in June 2010, and the Secretary of State’s predecessor announced plans for a “safe and independent authority” to which staff could turn when their organisations were not acting on concerns. Will the Health Secretary say why that has not progressed since then and assure us that there will be no further delays now that Sir Robert has reinforced that recommendation?
Although I believe that the Secretary of State’s commitment to improve the culture in the NHS is genuine, he will no doubt be concerned by Sir Robert’s findings that it might have got worse in recent years. In his report, he said about the cases he examined:
“Many were relatively recent or current. This is not about a small number of historic high profile cases from a time when organisations might argue the culture was different. We had a significant number of contributions about cases in 2014.”
The report specifically references figures from the latest NHS staff survey, which shows that reports of bullying have increased from 14% of staff in 2011 to 22% in 2013. Over the same period, the percentage of staff who feel able to speak out about poor care or to report errors or near misses has fallen from 98% in 2011 to 94% in 2013. Those figures suggest that things are getting worse, not better. Will the Secretary of State explain why he thinks that is and whether he will investigate the reasons further? That underlines the importance of any moves to improve the culture being introduced in the right spirit and being supportive rather than punitive, so that they do not reinforce the wrong culture and have the opposite effect to that which the Secretary of State is obviously trying to achieve.
At the weekend, the Secretary of State proposed fines and jail sentences for failure to be open about poor care. Although we support his zero-tolerance approach, is he certain that how this is perceived on the ground will not create a climate of fear and have the opposite effect?
Those concerns also apply to the new inspection regime introduced since the Francis report. In advance of today, I was contacted by a whistleblower who works in a hospital about a Care Quality Commission inspection planned for later this month and about the growing practice of hospitals running mock inspection days in advance of the CQC’s arrival, as schools have come to do with Ofsted. The whistleblower’s letter states:
“I enclose a document that invites us for a mock inspection to show us what to do and say when the CQC comes. Is this the correct thing to do? I think not. I cannot reveal my name as I would be instantly dismissed. Can you help?”
I am sure that the Secretary of State will be as concerned as I am to hear that and I will forward the information to him this afternoon.
I turn now to the Secretary of State’s update on the Francis report on Mid Staffordshire. Both sides of this House supported Sir Robert’s original recommendations and we give credit to the Secretary of State for making significant progress with their introduction, but gaps remain where progress has not been made and that is a concern when standards overall in the NHS are recorded to be falling, not rising.
In particular, there is a long-standing need to reform the system of death certification which goes back to Dame Janet Smith’s inquiry into the Harold Shipman murders. I took a personal interest in that as a Minister on the back of concerns raised by my hon. Friend the Member for Denton and Reddish (Andrew Gwynne)and James Purnell, the former Member for Stalybridge and Hyde. I legislated for reforms of death certification in the Coroners and Justice Act 2009, which made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to the coroner.
Following successful pilots, Sir Robert Francis reinforced Dame Janet Smith’s recommendation. Dr Suzy Lishman, the president of the Royal College of Pathologists, says that introducing these reforms will
“improve patient care whilst reducing harm and saving money”.
It will therefore be a cause of great concern to a great many people, not least the families of the victims of Harold Shipman, that those reforms appear to be stuck in the long grass. Chris Bird, whose mother Violet was one of those victims, recently told the “Today” programme that
“it is criminal that the Government is stalling on implementing something like this that could save lives.”
I have been informed by senior officials in the Secretary of State’s own Department that he personally is holding up this reform. Can he say whether that is true, and if so why? If it is not true, which I am prepared to accept, will he today set out a clear timetable for the introduction of this vital reform?
Alongside that, we need better arrangements in hospitals for reviewing case notes when patients have died, as the Secretary of State mentioned in his statement. Over the weekend, the Government announced plans to introduce an annual review from a sample of patients. Although that will help us to develop a more accurate measure of avoidable deaths than mortality rates, does the Secretary of State think it goes far enough? Should not the NHS learn from all serious failings? Will he give consideration to our suggestion that every death in hospital should be subject to an appropriate level of review?
We welcome the renewed focus on staff numbers since the Francis report, but we also remind the House that in the first three years of this Parliament almost 6,000 nurses were lost and, with record numbers of people in hospital, nurse-patient ratios have not kept pace with demand and there are fewer nurses per head of population now than in 2009-10. One of the problems with having made so many permanent staff redundant is that, post Francis, recruitment has been heavily reliant on agency staff. As Robert Francis warns today, that has made it even harder to get the culture right. We welcome the Secretary of State’s recent focus on nurse numbers, but will he concede that it was a mistake to cut staff so heavily? Will he back Labour’s plan to bring down the agency bill by recruiting 20,000 more nurses?
We welcome the progress made at some hospitals in special measures, but may I caution the Secretary of State on his use of statistics? Is he aware of the graph on page 8 of the Dr Foster report, which shows that mortality rates at the Keogh trusts fell faster between 2006 and 2010 than between 2010 and 2014? There was never a tolerance or denial of high mortality, as he seemed to suggest in his statement.
On openness and transparency more broadly, the Secretary of State will be aware that the King’s Fund delivered a damning verdict on the Government’s reorganisation, concluding that it had damaged patient care. That is consistent with a survey of NHS staff, which found that 69% said the reorganisation had harmed patient care, with only 3% saying it had improved. It is suggested that the Government’s own risk register on the reorganisation warned that reorganising the NHS at a time of financial stress would damage front-line care. So that any future Government can learn the lessons of the past few years, will the Secretary of State publish the risk register, as recommended by Sir Robert Francis?
In conclusion, as I have always said, the lessons from Mid Staffordshire need to continue to be learned if the NHS is to be what we all want it to be: the safest and best health care system in the world. The Secretary of State has today taken some important steps towards that goal, but I hope he will respond fully to the serious questions I have raised.
I welcome the broadly constructive tone that we have heard today. May I say, in that spirit, that I hope that that represents a change in substance from some of the other exchanges we have had on these topics? The right hon. Gentleman tried to vote down the legislation that set up the new chief inspectors and he opposed the holding of a public inquiry into Mid Staffs. If we are to have constructive agreement across the House, I do think we need to agree on substance as well as on tone. Let me just take the individual points he mentioned.
We are completely committed to death certification. That was recommended in the wake of the Shipman inquiry. The right hon. Gentleman’s Government took a very long time to do anything on this and we have been trying hard to do it. It is a complicated thing to get right. On the question of looking properly at avoidable deaths, I just want to say this. It is very difficult, when one looks at case notes, to work out whether a death was avoidable or not, but we think we have a methodology to do that. It is more difficult to relate that to individual trusts, but we want to try to achieve that as well. I was disappointed at the weekend that when we announced that, his response was that it was unambitious. Two weeks earlier, he had published Labour’s 10-year plan for the NHS, which did not actually mention reducing avoidable deaths at all. What we are proposing is the most ambitious thing that any health care system has proposed anywhere in the world, and I hope it will have his full support.
On the right hon. Gentleman’s comments about not generating a climate of fear, he is absolutely right; it is really important, in getting the culture right, to make sure that people are supported to speak out and that there is not, as an unintended consequence, the kind of bullying and intimidation that Sir Robert says is all too common today. I suggest to him that one of the reasons for that climate of fear has been over-dependence on top-down targets as a way of running the NHS. That is what has created the fear in managers that sometimes has led them to treat their staff in the wrong way. What would be very constructive would be a recognition from Labour that that top-down targets culture did go too far, and that we need to rely on transparency as a way of improving performance as a much better tool than endless new targets.
In anything we do—this is something else where I agree with the right hon. Gentleman—we must look very closely at making sure that we learn these lessons in the social care sector as well. That is particularly clear when we look at the scandal of what happened in Rotherham. That is why, when we introduced the new CQC inspection regime following the original Francis public inquiry, we did not just set up a chief inspector for hospitals but set up a chief inspector for general practice and for adult social care. We are now getting the same Ofsted-style transparent rankings of how good care is in care homes, and indeed in domiciliary care. I know that he, like me, is concerned about 15-minute care visits. I think those inspections will help to root out those problems.
With respect to nurse numbers, I really do think that is something on which, if the right hon. Gentleman wants to be constructive, he should commend the Government’s efforts. We have 8,000 more nurses in our hospital wards than we had four years ago. Of course, as a short-term response a lot of hospitals are employing nurses through agencies. That must only be a short-term response. We need proper long-term commitment to institutions, which we do not get with agency staff, but I commend hospitals that have said, “While we try and get enough staff in place for the long term we are not going to wait, because we need to make sure that patients are safe today.” They want to do what it takes to do that.
Finally, on the risk register, I simply remind the right hon. Gentleman that when he was Secretary of State he blocked the publication of the risk register. As a Minister, he said:
“This would inhibit the free and frank exchange of views about significant risks and…management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]
More broadly, I just want to say this. There are many patients and whistleblowers looking at today’s exchanges and wanting to see constructive agreement on the way forward. I think we can get a measure of that. What they say they want is not just words, but actions.
As we put staff and patients first in England, will Labour do the same for patients in Wales and today commit to a Keogh review of high mortality hospitals, commit to a chief inspector of Welsh hospitals and commit to protect staff who speak out in Wales, as we want to do in England? Will he commit to putting right a top-down culture that prioritised the needs of the system over the needs of individuals? Will he, as we do, recognise that that is always the danger of treating the NHS as a political possession and not as a service for patients? Patients must always come first. Staff who want to do the right thing for patients should always be heard. Our NHS deserves nothing less.
May I endorse the Secretary of State’s remarks on Wales, having seen it at first hand? Having seen at first hand a constituent who was a whistleblower, and how her career and her family life have been so badly affected after she did the right thing, I know that what the Secretary of State has done today will be widely welcomed.
On the Public Administration Committee, we took evidence from the CQC and others, and it became very obvious that there is still a major problem with complaints procedures for patients and their relations. Patients often tell me that they are afraid to complain about the way that they are being treated in whatever NHS establishment they are in. Is there some way in which the Secretary of State can ensure that there are clear instructions in all NHS establishments on how patients and their relations can raise their valid concerns without their worst fears being realised?
Order. The right hon. Lady, whom I know extremely well as a Buckinghamshire colleague, rather like Treebeard does not believe in unnecessary or undue haste, but if I could suggest to colleagues that questions could be pithy rather than too leisurely I think we would all profit from that. The same goes, of course, for the Secretary of State, from whom we expect characteristically pithy, succinct responses.
As indeed we learn from you, Mr Speaker.
I welcome the question from my right hon. Friend, who is a former Secretary of State for Wales. People will want to know that these lessons will be learned in Wales. In the original Francis response, we set out clear plans for the way in which hospitals should make it clear, in every ward of every hospital, how one can complain not just directly to the trust, but to independent external organisations, such as the ombudsman, if necessary.
May I warn the Secretary of State not to think that because he has decided something and because a circular has been issued, something has happened? In 1998, against a lot of opposition, I insisted that the whistleblowing law should apply to the NHS. I also issued a circular banning the use of gagging clauses. As I said in my discussion with Sir Robert Francis on this whole issue, it clearly did not work.
I thank the right hon. Gentleman for what he did when he was Health Secretary. I am well aware that in the world’s fifth-largest organisation, nothing happens just because someone issues a circular, which is why some of what we have announced goes beyond what Sir Robert precisely recommended. For example, by publishing avoidable death rates by hospital trust, we want to make the energy for change come from inside trusts, not from their being told to do things by Ministers. However, I welcome what he did as Secretary of State, and I hope we can do some other positive things.
May I commend my right hon. Friend for his nuts-and-bolts approach and Sir Robert Francis for what is clearly an extremely good report? My right hon. Friend will know that Helene Donnelly is a constituent of mine, and that I read out a letter from her in Westminster Hall when I called for an inquiry under the Inquiries Act 2005—an inquiry that this Government set up, despite its having been refused by the previous Government and successive Secretaries of State. Will he bear in mind the need to dismiss any chief executive who does not take account of lessons learned and the fact that anyone who puts a whistleblower at risk does not deserve to hold their job?
I thank my hon. Friend because without his work and that of some of his Staffordshire colleagues we would not have had a public inquiry into Mid Staffs in the first place. Helene Donnelly has been a great inspiration to everyone who has thought hard about this subject. She had the courage and guts to stand up for patients at Mid Staffs, and she experienced terrible bullying as a result, which is why I am delighted that she is helping us. In fact, I think she is the inspiration for Sir Robert’s recommendation on “freedom to speak up” guardians. My hon. Friend is absolutely right that managers and chief executives must be completely accountable for delivering on this agenda, but we also need to send a signal to them that success for a chief executive means more than meeting A and E or 18-week targets; it is about the quality and safety of patient care.
May I support the suggestion from my right hon. Friend the Member for Leigh (Andy Burnham) to extend to social care the measures recommended by Sir Robert Francis? I know from my own casework how hard it is for a whistleblower in social care working for a small organisation to reveal issues of bad care. In addition, the Health Select Committee pointed out that many whistleblowers suffer in their careers, including in social care, lose their job and find it hard to find a new post, and it recommended that whistleblowers who are vindicated receive an apology and practical redress. Does the Secretary of State agree?
I agree with the hon. Lady’s argument. Just as poor care has been identified in hospitals, so we have seen terrible examples of things happening in residential care and of inadequate domiciliary care. It is more complex, because the delivery of social care is more diffuse, but one way to deal with this is through the proper integration of health and social care and the proper assessment of quality based on the entire package of care that people receive, not just in individual institutions but across the board. We are doing a lot of work on that.
Like others, I welcome the report, but may I urge my right hon. Friend to reconsider the issue of safe staffing levels on acute hospital wards? I know that Robert Francis pointed to issues of culture and standards, but those are areas of interpretation and disputation. If we had the measuring stick of safe standards, particularly where a ward has less than one registered nurse to seven acutely ill patients—the level recommended by the Safe Staffing Alliance—whistleblowers would be able to point to a clear failing and service risk, which is especially important if the Secretary of State is worried about avoidable hospital deaths.
The hon. Gentleman makes an important point, but I hope I can reassure him, because NICE has published guidelines on safe staffing levels, although they are different for different parts of a hospital: in intensive care, it is 1:1; for less severe illnesses, it is one nurse to eight patients; and in other parts of a hospital, it is one nurse to four patients. Those are all published, and I hope they will help whistleblowers in Cornwall and elsewhere.
What support will the Secretary of State give to trusts to ensure that safe staffing levels are implemented, given that they might need extra resources?
We have protected—indeed increased—the NHS budget in real terms at the time of the biggest financial crisis since the second world war, so I think the Government have done what they can to make resources available. However, improving care is not always about money, and some hospitals manage to staff their wards safely and achieve financial balance. In fact, hospitals that practise safe care tend to be in a better financial position than ones that do not, so safe care and good finances actually go together.
I commend my right hon. Friend for his statement and thank Sir Robert Francis for his excellent report, which, as the Secretary of State knows, goes to the heart of the Public Administration Committee’s inquiry into clinical incident investigation. It comes as no surprise that we still have severe problems in the NHS. Perhaps the “freedom to speak up” guardian role needs to provide complete legal protection for people speaking up, immunity from freedom of information requests so that the information and the names cannot be exposed maliciously, and the capacity to investigate what is reported to them on a completely independent basis. We look forward to his giving evidence to our Committee.
I thank my hon. Friend for his interest in the issue of culture change, including at his local hospital, which I visited last week and where I was pleased to see a change in culture happening, despite some very severe problems. It is excellent that PASC is doing this inquiry, and his suggestions sound very worth while. We will consider them as part of our consultation—in fact I would encourage his Committee to submit them formally, to ensure that we give meaning to these “freedom to speak up” guardians.
I welcome the report by Sir Robert Francis and the Secretary of State’s commitment to changing the culture around the protection of whistleblowers—the Health Committee recently published a report making specific recommendations about such protections. May I draw the Secretary of State’s attention to the actions of the General Medical Council, which wrote to the employer of a whistleblower who gave evidence to the Committee after he had expressly stated that he was acting in a personal capacity in raising questions and providing evidence of financial inducements being paid by private health care companies to secure referrals?
I am happy to look into that case carefully, if the hon. Gentleman will supply me with the details.
In calling the hon. Gentleman, I congratulate him on his wedding. We wish him a long and happy marriage.
Thank you, Mr Speaker.
A good friend of mine, a consultant cardiologist, had his career ended and his life completely disrupted after he blew the whistle on the unnecessary deaths of patients at a hospital he worked at. It has taken him more than 12 years to win his case at a tribunal, and he still awaits compensation. These cases often manifest themselves in employment disputes, with trumped-up charges brought against the individual. What can the Secretary of State do to ensure that such things never happen again?
I add my congratulations to my hon. Friend, who makes an important point. The heart of the problem of whistleblowing is the confusion between employment law and patient safety. We need to divorce those two things and put in place a proper procedure to ensure that the right thing happens if someone raises a concern about patient care, and that it can be externally investigated to ensure that the trust did the right thing. Issues of employment law and someone’s professional behaviour should be pursued on a completely different track—those things are rightly and properly a matter for the courts. It is precisely because of the kind of issue he talks about that people are afraid to speak out. They worry that if they do, even if they win at an employment tribunal, they might never get a job again. For that reason, we welcome the shadow Secretary of State’s commitment to work with us and put on the statute regulation-making powers making it illegal for NHS organisations to discriminate against former whistleblowers.
The Secretary of State and I spoke last week about the importance of the upcoming Kirkup report. Grieving families in my constituency want to be able to move on from the tragedies they have suffered and see proper change in the culture at Morecambe Bay. What happened was not right and is still under criminal investigation. Will the improvements the right hon. Gentleman has announced today be in place when the report is published, and does he agree that the response to it must be neither whitewash nor witch hunt? If he does, how can he help make it happen?
I thank the hon. Gentleman for the close interest he has shown in this issue and the constructive way in which he has engaged with families locally to try to get to the bottom of a really terrible tragedy. He puts it better than I could. We need to implement the recommendations in a tangible and real way so that something actually changes, but we do not want to do it in a way that has unintended consequences. That is why the focus of what Sir Robert is saying this time is not about new criminal sanctions. Although the law has a role—we changed the law on wilful neglect, for example—this is about creating a supportive culture through which people want to listen and learn when others speak out. Of course, if people do not, there should be sanctions, but that should not be the primary motivator.
I was pleased to be with the Secretary of State last Thursday when he visited Colchester general hospital—one of 19 in special measures—and I am sure he will want to join me in praising the hard-working medical and support staff for all they are doing. He referred in his statement to the “entire NHS” being “committed to patient-centred culture change”, and observed that no one takes responsibility for a vulnerable patient so that the buck gets passed. I suggest that Sir Robert Francis would do well to look at the silo mentality—the reality rather than the rhetoric—in the case of the Haven Project in Colchester, to which the hon. Member for Harwich and North Essex (Mr Jenkin) and I have drawn attention. That is a classic case where the reality does not match the rhetoric.
Yes, and I remember the conversation I had with the hon. Gentleman about that issue. I will look into the case carefully. I am not saying that the NHS culture is changing today, because I think it is a very long journey. That is why it is important to have cross-party agreement. This is something that will take decades to happen. If we look at the best hospitals in the world, in England or abroad, we find that they get their culture right over decades. We must understand that. Breaking down those silos, putting patients first and making sure that that is not compromised, whatever the external pressures—that is the heart of the matter.
When Pauline Lewin, a whistleblower, came forward in Hull to raise concerns about the then chief executive, Phil Morley, she found herself subject to hostility and bullying and has not been able to return to work—despite corroboration from a damning Care Quality Commission report, an ACAS report that established bullying and an independent KPMG report on financial irregularities. Meanwhile, the chief executive has moved on to another such post, earning £170,000 a year. I listened carefully to what the Secretary of State said—that he was “calling time on bullying…and victimisation” in the NHS—so will he reassure me that that will apply to this case, which his Department is currently investigating?
I remember the good meeting I had with the hon. Lady and the former Secretary of State about that issue, which we are looking into. I hope she will understand that it would not be right for me to comment on that individual case, but let me say that it seems to exemplify exactly how things have gone wrong. That is why we need to look into it very carefully. We need to create a culture through which the management actually want to listen to their staff. I do not want managers to do so because of something I say; I want them to feel that they want it happen. It is as much about making sure that organisational priorities are correctly set from the centre, as it is about changing the law.
Culture change is a big tanker to turn, and senior managers under pressure from targets and headlines need significant sanctions and incentives to reveal rather than smother or downplay difficult truths. Doctors have the General Medical Council, although it needs improvement, but managers have no regulatory body to make them accountable. Will the Secretary of State consider doing something about that?
I thank my hon. Friend, whom I know has thought extremely hard about this issue. Indeed, we talked yesterday about getting the fit and proper persons test to work properly. It is still in the early stages, so it is difficult to assess whether it is having the impact we want. We certainly hope it will have some impact. There is an unfairness about the fact that a clinician as a chief executive of a hospital is accountable to the GMC as a doctor, whereas a chief executive who is not a doctor is not accountable. We actually want more doctors to become chief executives. On the whole, they do a really good job, and we should give further consideration to that.
It will take a great deal to change the culture. I have spoken to a senior hospital manager who would like to express his concern about the lack of qualified nurses, forcing him to advertise posts abroad. I have spoken to two A and E nurses who are concerned about the critical situations occurring at their unit every day. One of them has become an agency nurse so she can limit the number of hours she is forced to work. Then there is an ambulance worker who is concerned about the 12-hour shift and the lack of time he is given to clean his ambulance between dealing with patients. They would all like to come forward to express their concerns, but they do not feel that anyone above them would listen. What can the Secretary of State say today to reassure those people?
I can say that we are consulting on making a big change that would mean they would have someone independent in their organisations to whom they could talk and raise their concerns. They could say, “I want to say this, but no one is listening to me”. That is what Sir Robert Francis calls “freedom to speak up” guardians, whom he wants in every organisation. It is what Helene Donnelly is championing in her work. That is the way forward to address those concerns.
East Lancashire Hospitals NHS Trust was placed in special measures, following the Keogh review, in July 2013, and it successfully exited that regime in July 2014. The trust has employed an additional 201 nurses and nursing support staff and 26 more doctors since June 2013, taking the total increase since May 2010 to 391 additional nurses and 40 additional doctors. In January 2014, the Royal College of Midwives named the maternity services unit the maternity service of the year. Will my right hon. Friend join me in paying tribute to the dedicated staff at East Lancashire hospitals for working with the new tougher regime and turning my local hospital trust around?
I absolutely will. This is a great example, and I would like to thank my hon. Friend for the interest he has shown in this issue. For one hospital to have 390 more nurses over four years is remarkable. It may interest my hon. Friend to know that those numbers do not include agency staff, so if the hospitals have any such staff, they will be counted on top of those figures. This is a dramatic turnaround for the quality of patient care, which we all welcome. That just shows that if we get the incentives right from the centre, trusts do want to do the right thing. We did not instruct the trust to employ a single extra nurse; rather, we set up a new inspection regime and special measures regime, and what my hon. Friend said shows it has worked.
I, too, welcome the report. In his statement, the Secretary of State committed to the view that the new measures are not about “naming and shaming”. Does he therefore agree with the Prime Minister, who said:
“Francis does not blame any specific policy. He does not blame the last Secretary of State for Health. And he says we should not seek scapegoats”?
I do not think we should seek scapegoats, but I do think we need to understand where policies have inadvertently led to the wrong outcomes. Sir Robert talks clearly about the dangers of an excessive focus on targets, which is one of the things that have driven the wrong culture. On that, I hope to get cross-party agreement.
As my right hon. Friend will be aware, one reason why Basildon hospital came out of special measures so quickly is that under the new chief executive, openness and transparency are is encouraged at every level. Does he therefore agree that it should be incumbent on all of us to be open, transparent and honest? Why does he think the Opposition are tweeting that the numbers of doctors and nurses at Basildon hospital are down, when I have just checked with the chief executive and found that the reality is that the numbers are up?
It is very important that everyone uses the right figures. What has happened at Basildon hospital is an inspiration to other trusts in special measures. In just a few months, it moved from being in special measures to being rated “good” by the CQC. The trust has an inspiring new chief executive, Clare Panniker, who really does listen to staff. I have been there and been told by staff how they feel that they are being listened to. We all have an obligation to make sure that the right information goes out to local communities, so that they understand where things really are getting better.
Most, if not all, hospitals are very concerned about next year’s proposed 3.8% efficiency saving. They fear that it will have an impact on access to and quality of services, and hence on patient safety. In the spirit of the openness and transparency that we now want to see, may I ask whether the Secretary of State was aware of those concerns, and whether, if he was not, he will find out why?
I am glad to note that this is rapidly becoming one of the most open and transparent exchanges of questions and answers we have had in the Chamber. I am, of course, aware of trusts which say that they will find it difficult to meet stretching efficiency targets, but I would say to them that if they look at some of the safest hospitals in the world—such as Salford Royal in England and Virginia Mason in Seattle—they will find that they have the lowest costs. It is not a choice between cost and safety; better safety leads to lower cost.
Will my right hon. Friend join me in welcoming the progress that has been made at George Eliot hospital since the Keogh review? The employment of 91 extra doctors and nurses has certainly helped, but does he agree that we cannot be complacent and must continue to root out bad practice wherever it exists, in a very open and transparent fashion?
Absolutely. I have visited George Eliot hospital, and observed a few beds in the A and E department. One of the most inspiring things about it is that it came out of special measures by developing a strong link with University Hospitals Birmingham NHS Foundation Trust—under the leadership of Dame Julie Moore—which enabled it to learn very quickly what changes were needed. The “buddying” of trusts in difficulty with high-performing trusts is one of the measures that have worked the best.
I am pleased that the report mentions support for the right of NHS workers to speak up. When I was a Unite workplace rep in the NHS, I spent much of my time giving support and advice to workers who asked about blowing the whistle on malpractice. Does the Secretary of State recognise the vital advisory and supportive role provided by trade unions in the NHS, and will the Government cease their attacks on trade union facility time?
I agree that unions have an important role, but this should not have to be about unions. Regardless of whether a hospital has unions, people should be able to contact someone independent if they feel that their concerns about poor care are not being listened to, and that person should be enthusiastic about listening to what they say.
This morning I was contacted about a patient at Basildon hospital who was suffering from Parkinson’s disease and who, on asking for assistance to go to the toilet, was told by nurses that they were too busy, so he had to use his pad. He was left in some distress, and suffering from nappy rash. Does my right hon. Friend agree that, when we are developing a patient-centred culture in the NHS, such behaviour should not be tolerated?
I do agree, and I have had many discussions with my hon. Friend about how local health care services can be improved. It shows real courage to raise a concern about patient care at one’s own local hospital. Basildon is a fantastic hospital—it is very well run, and it has really turned a corner—but that does not mean it is perfect, as I am sure its chief executive would be the first to accept. It is possible to have a sensible debate about improving care while being honest about the problems. That is the big change we need to make, and my hon. Friend has given us an example.
I welcome the focus on whistleblowers and the support package, but the Francis report also said that patients’ complaints should be viewed as the canary for failing hospitals. What support is the Secretary of State giving to patients who make complaints, and can he reassure us that the hospitals and the Care Quality Commission will take the issue very seriously?
Yes. We have set out new guidelines. The right hon. Member for Cynon Valley (Ann Clwyd) helped us a great deal when we were looking into how to improve the NHS complaints procedure, in particular advising people about how to complain and ensuring they knew that they could talk to someone independent if they needed to. I try to look at a letter of complaint about something that has gone wrong in the NHS every day before I start my work, and I make sure that the trusts are aware of that.
Before Christmas, I alerted Ministers to attempts by Gloucestershire Hospitals NHS Trust to prevent a governor from expressing concern to the local media about the care of local people. Does the Secretary of State agree that gagging governors is also unacceptable, and that the new spirit of openness should apply to governors and board members as well as staff?
I do, and I think it important to bear in mind the role of the press as a last resort for whistleblowers. Many of the problems of which we are aware have come to light because people have spoken to the press, and that is to be welcomed, but I think we would all agree that it is a real shame if things have to reach that stage. We need a culture in which people are listened to straight away. That governor should have felt that he or she could talk to someone in the hospital who would do something about the problem, rather than having to go to the press.
The Secretary of State has said that trusts are becoming more transparent in relation to data, and of course that is welcome, but data alone may not provide full information for patients. In 2011, Trafford general hospital had very poor standardised mortality figures, but, thanks to the assiduity of my constituent Mr Dennis Wrigley, we now know that they were due to a recording error. How will the Secretary of State encourage trusts not just to provide raw data, but to contextualise the data and tell patients what they might mean?
I hope the hon. Lady will be pleased to know that we have now made it a criminal offence to supply false or misleading information, but let me respond to the broad point that she has made, because I think it is important.
The publication of data is indeed welcome, but we do not want it to cause the entire NHS to focus on gaming the system, or changing the way in which data are collected in order to make its organisation look better. The purpose of data is to identify issues. The CQC then makes rounded judgments on the performance of institutions, which are based not just on data but on visits and conversations with patients, doctors and nurses. I think that that system can provide us with the best understanding of how well those institutions are actually doing.
As the Secretary of State will know, my hon. Friend the Member for Bristol North West (Charlotte Leslie) and I wrote to him about Southmead hospital after a large number of our constituents had written to us about poor quality care there. Today the CQC published its report on North Bristol NHS Trust and Southmead, which states that the urgent and emergency services are inadequate and causing a
“serious risk to patients’ safety”,
and also states:
“Several staff told us they were ‘ashamed’ of the standard of care”
I have just received a letter from the chief executive of North Bristol trust, which makes no mention whatsoever of the fact that Southmead A and E had been declared inadequate. Instead, she simply refers to
“some teething problems which are being dealt with”.
Does that letter not illustrate the overall culture problem in the NHS, namely that there is active denial among some chief executives who will not admit what is going wrong in their local hospitals?
I have not seen the letter, so I hope that my hon. Friend will understand if I do not comment on it, but I strongly agree with his broader point. Any chief executive or manager in the NHS needs to understand that the best way in which to reassure the public, and to reassure Members of Parliament who speak out for their constituents, is to be honest about the problems.
My local trust was the first in the country to be given an “outstanding” rating. When I last went to see its chief executive, I said that I had three constituency problems, and I raised all three of them with him. He said, “Yes—we were wrong on that one; we should not have done that; and we were wrong on that one.” One of the best trusts in the country was being totally honest about its problems, and wanted to do better. We need to make managers understand that that is the right thing to do, and that we will back them if they do it.
Longton cottage hospital had to close because the local trust could not recruit enough nurses to ensure its safe operation, yet the Government slashed nurse training places. Now the Department refuses to release the secret KPMG report on “distressed” health economies. The people of Stoke-on-Trent deserve to know what is happening to their local hospitals and to local health care. The Secretary of State rightly says that we need to stop secrecy and have openness, but when will he whistleblow his Department’s own report? The Department is setting a very bad example when it comes to openness and transparency.
I will look into the issue that the hon. Gentleman raises, but let me deal now with the issue of nurse training places. The cuts began under the Labour Government, and we have been gradually reversing them. The main point, however, is that, in all parts of the House, there was a lack of understanding of the importance of safe staffing in wards before the Francis report, which is why successive Secretaries of State made mistakes in their projections of what was needed.
We have 8,000 more nurses in our hospital wards, including those at Stoke, and I hope the hon. Gentleman welcomes that.
The Secretary of State will want to congratulate North Lincolnshire and Goole NHS Foundation Trust on getting out of special measures and employing more nurses and doctors. On the issue of “freedom to speak up” guardians, will he ensure there is one in every hospital, because in my trust staff in the smaller hospital sometimes feel their voice is not heard by the two big district general hospitals, which are up to 60 miles away?
That is a very good point. I had a great visit to my hon. Friend’s local hospital and saw a knee operation which was quite gory but looked to me to be a very good example of safe care. He makes a good point and I will certainly feed into the consultation the idea that it should be easy to contact somebody who works in the same hospital or building, rather than someone who is a long way away.
When I entered this House in 1987 I was put on a Select Committee for the parliamentary ombudsman, which dealt with the health service and complaints within it. In bad cases, we would bring chief executives, chief nurses and chairmen of the trust concerned before us. That was a good deterrent. Why not bring it back?
All these things should be looked at, but through the Select Committee on Health we do now get chief executives of trusts to be accountable to Parliament. The Public Administration Committee is looking at the role of the ombudsman to make sure that works as well as it can, and we should wait for its recommendations.
Following on from the question of the hon. Member for Barrow and Furness (John Woodcock) about Morecambe Bay trust, has the Secretary of State had a chance to look at yesterday’s “Better Care Together” future plans report by the trust, which finally puts to bed the wild allegations locally of hospital and A and E closures and also sets a road map for eliminating the pre-2010 deficit, provided we get some recognition of the difficult geography of our area?
I know geography is a big issue, and the driving distance between Morecambe bay and Lancaster is a big challenge for the trust. I will look closely at that report, and I think Members in all parts of this House would welcome a commitment to avoiding scaremongering about local hospital services in the run-up to the election.
I represent a constituency in Wales, and look with some envy at the commitment to openness and transparency on both sides of this Chamber, and indeed the commitment to transparency and openness throughout the NHS in England following the Francis report and the Keogh review. What discussions can my right hon. Friend initiate, perhaps with the Opposition, to introduce the same level of transparency and openness in Wales so that my constituents in Montgomeryshire can also benefit?
I think it is very simple—there is a lot of agreement between us about what needs to happen. I recognise that the shadow Secretary of State is not personally responsible for what happens in Wales, but his party is, and a Keogh review of high mortality hospitals, a chief inspector of hospitals for Wales and a commitment to the whistleblowing measures announced today would do a lot to allay the concerns of my hon. Friend’s constituents that the lessons about openness are not being learned across the border.
Does the Secretary of State recall that the Care Quality Commission found that in East Kent hospitals senior management and the front line were disconnected, there were problems with bullying and harassment, and people would not say how things could be improved, including in terms of clinical risk? Does that not indicate that this is not just about whistleblowers, but that it is important that management sets a culture of openness, and listens and hears the staff voice?
My hon. Friend is absolutely right, and I thank him for his interest in his local hospitals and his campaign for them. In the end, culture comes from the top. When people start a job they look at the values of their direct line manager and they copy them, because they think that is what it takes to get on, and the line manager looks to the chief executive and the chief executive in the end looks up to the Secretary of State, so it is very important—[Interruption.] I grant that that may not be the best thing. It is important that right from the top we set the right example about these issues.
I thank my right hon. Friend for the work he has done on this and for his forthcoming visit to Princess Alexandra hospital in Harlow. Further to the question on trade unions, we have outstanding trade union representatives in the Princess Alexandra hospital and they do a huge amount of work on these issues. Can my right hon. Friend confirm that these guidelines will also include trade union workers, so that they are covered by his recommendations?
That is an interesting point and we should certainly reflect on it in the consultation. I am looking forward to visiting my hon. Friend’s trust in March. On many of the visits I have made to hospitals in special measures, which his hospital is not, I have met union representatives and they have an important contribution to make, because nine times out of 10 the real problem is that the people on the front line feel they are not being listened to, and when that is put right the other things start to be solved as well.
As a former airworthiness engineer, may I strongly endorse my right hon. Friend’s direction of travel? Will he confirm that Buckinghamshire Healthcare NHS Trust, having exited special measures after the Keogh review, has enjoyed a fantastic transformation, which I believe he saw when he visited Wycombe hospital?
I had a fantastic visit there. This was a hospital that, putting it bluntly, was one of the worst in the country, and it is now on its way to becoming one of the best. The motivation and excitement not just of the management team but also the staff there, were palpable, and I think a huge number of good things are happening. What has worked there is the sense that what we are asking of the hospital is the same thing that they want to deliver for their patients—safe, compassionate care—and that must remain the focus.
Point of Order
On a point of order, Mr Speaker. I provided your office with a copy of the minutes of the petitions committee of the European Parliament of 11 November—
Order. The hon. Gentleman is a remarkable denizen of this House and it was very good of him to give me advance notice of what he wanted to cover, and I am genuinely sorry to interrupt him. He has indeed, as he rightly says, given some advance indication of the question to which he seeks an answer from the Chair. However, the issue he raises, and which he did, as I say, courteously treat of with my officials in advance, is in my view more properly raised not as a point of order in the Chamber, but in discussion between the hon. Member and me and my advisers, since raising the matter orally in the Chamber may itself, no doubt inadvertently, breach the rules of the House. I should therefore be grateful for the hon. Gentleman’s forbearance, and let me say for the avoidance of doubt that to welcome the hon. Gentleman to Speaker’s House for a meeting around the table with my advisers over a cup of tea will be an enjoyable experience for me, and I hope also for the hon. Gentleman, and I look forward to him speedily getting in touch with my office to arrange that agreeable encounter. Perhaps we can leave the matter there for today?
In terms of discussing this at the Procedure Committee, the fact that I cannot even raise the point of order is in itself a useful piece of information for it to consider.
Well, it has to be said that the hon. Gentleman is a distinguished member of that Committee and I feel sure he will advise it of his views, as he has always done—with alacrity—in this House. We look forward to further and better particulars in due course, and I am grateful to the hon. Gentleman for his understanding.
Job Creation Powers (Scotland)
Motion for leave to bring in a Bill (Standing Order No. 23)