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Barts Health NHS Trust

Volume 594: debated on Thursday 19 March 2015

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on Barts Health NHS Trust being placed into special measures.

The NHS Trust Development Authority announced on Tuesday 17 March that Barts Health would be placed into special measures. This followed a report by the Care Quality Commission which rated services at the Barts Health site at Whipps Cross as inadequate. As a result of this decision the trust will receive a package of tailored support to help it rapidly make the necessary improvements for patients. This will include the appointment of an improvement director and the opportunity to partner with a high-performing trust. The chief inspector of hospitals has highlighted the scale of the challenge ahead and this is an opportunity to ensure that the trust has the extra support it needs to meet that challenge. Barts Health has already announced that it has begun to strengthen management arrangements at Whipps Cross, in response to concerns raised by the CQC.

We make no apology for the fact that, under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is providing inadequate care and we do not have confidence in the ability of its leadership to make the required improvements without intensive support, it will be put into special measures. It will remain in special measures until it is able it to reach the quality standards that patients rightly expect.

While the trust is in special measures, it will receive increased support and intensive oversight to help it address its specific failings. This process is publicly transparent, so patients and the public can see and track for themselves, online through the NHS Choices website, the progress that their trusts are making. Any changes or additional support required for the trust leadership are put in place early on in the improvement process, as has already taken place at Barts Health.

The expectation is that an NHS trust or foundation trust will be re-inspected by the CQC within 12 months of being placed in special measures. It is the job of the chief inspector of hospitals to recommend when a trust is ready to exit special measures. The NHS TDA or Monitor will then formally decide to take the trust out of special measures when it considers the trust is able to sustain the quality of care at the level patients rightly expect.

Barts Health NHS Trust is no ordinary hospital trust: it is the largest NHS trust in England, employing more than 14,000 staff and treating patients from all over London and indeed the whole country. Importantly, it is also one of the few trusts directly managed by the Trust Development Authority and the Department of Health.

Is it not true that the problems at Whipps Cross have been known for some time and have not just been uncovered this week? Is it not also true that these problems have been allowed to get worse over the past two years, with 208 serious incidents in the last year alone, and that specific warnings have not been acted on? Given all this, is it not a cause for real concern that this trust has become the 20th to be placed in special measures under this Government? People in east London need to know why, and what is being done to bring their hospital back up to an acceptable standard. Does the Minister accept that, given the seriousness of this issue, they are entitled to be disappointed that the Secretary of State is not here today to respond to these concerns?

One of the report’s main conclusions is that the root cause of care problems in the past two years was the reorganisation of the trusts in 2013. It states that

“the decision…to remove 220 posts across the trust and down band several hundred more nursing staff had a significant impact on staff morale and has stretched staffing levels in many areas”.

These findings raise significant questions for the Department and Ministers. Given that it is a directly managed trust, was a proper assessment made of the reorganisation plans, and was it signed off by Ministers? Why did Ministers overrule the Co-operation and Competition Panel, which advised against the proposed merger and warned of material costs to patients? What action did the TDA, the Department and Ministers take on the warnings raised at the time?

The Minister will know that my hon. Friend the Member for Leyton and Wanstead (John Cryer)—I am afraid he has a constituency engagement this morning; otherwise, he would have been here—and, as I understand it, her Cabinet colleague the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), raised specific concerns about the decision to remove the management structure from Whipps Cross Hospital, concerns echoed by my hon. Friend the Member for Walthamstow (Stella Creasy). Why were those concerns ignored, leaving Whipps Cross without an adequate management structure?

Looking ahead, can the Minister say more about what is now being done to improve management at Whipps Cross, and to reassure local people that their hospital is safe? What immediate steps are being taken to improve staff numbers? On finance, is she aware that the bill for agency staff across the trust has gone up by a huge 44% in the last year alone, and what is she doing to bring that down? It is unsustainable and unaffordable, but it is also damaging standards of patient care on the ward and continuity of care.

The inspection took place in November. Why was it published only this week—one day before the Budget? Given that this is about a failure of NHS management, why is the Department of Health still sitting on the report by Lord Rose on NHS management? Will the Minister give a firm commitment to this House today that it will be published before Parliament is dissolved?

This report has been widely described as the worst assessment ever seen from the CQC. It will be seen as a symbol of the decline of the NHS on this Government’s watch, and people are looking now, today, for an urgent plan to turn things around.

The whole House will have noted that the right hon. Gentleman asked why the report has only just come out. He might reflect on his own time in office, when there were reports that did not come out at all just before the general election. If there is any better example of weaponising the NHS—we have just seen it. Instead of trying to make political capital, should the right hon. Gentleman not admit that the new CQC inspection regime illustrates exactly why transparency is so important, and why this Government were right to implement it?

Under the previous Government, failures of care were swept under the carpet and not acted on, which led to the tragic consequences we know about. Before the last general election, Labour tried to block the publication of a devastating report into Basildon and Thurrock hospital. [Interruption.] These are serious matters, and that is exactly why the CQC inspection has to be taken seriously. As I have said, local management is looking at these important issues, some of which we have debated before in the House, and which need to be addressed very seriously. However, the hospital management are beginning to do that, and they must take such action to ensure that they bring care up to the right standards.

All the things that the CQC has identified have to be addressed. As I have said, this illustrates exactly why the new CQC inspection regime is so important. Even now, a week before Parliament dissolves before the general election, this Government are committed, without fear or favour, to transparency and to bringing out this report. We are committed to ensuring that we put into the public domain the measures that need to be taken to put that hospital back on track and to ensuring that its patients can have confidence in the safety of its operation.

This is a very serious matter, and it is extremely important that it should be brought to the House. I am pleased that the Francis report on Mid Staffordshire resulted in the appointment of a chief inspector of hospitals, which has led to the production of reports such as this, but does the Minister agree that this case highlights the vital importance of having proper safety systems within each health and social care provider, as is proposed in the Health and Social Care (Safety and Quality) Bill, which is now going through the House of Lords with the support of the Opposition and the Government? Will she ask the CQC to ensure that each hospital and social and health care provider that it inspects has such safety systems in place and that that includes management systems, to ensure that the providers cannot make cuts that would put patient safety at risk?

I pay tribute to my hon. Friend’s remarkable work in this Parliament on campaigning for transparency in patient safety. He is exactly right to say that these are important features of the inspection regime. As I have said, work has already begun to strengthen the management arrangements at Whipps Cross, but he is right to say that patient safety must be the predominant concern of the management when they come to address failings such as these.

Whipps Cross is my local hospital. I have been a patient there and my family have been patients there, as have friends and neighbours. I join the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) and my hon. Friend the Member for Leyton and Wanstead (John Cryer) in being horrified at what I am sure they would see as the Minister’s insulting response to this issue. She is playing politics with the hospital that serves our community. We all want to put on record our support for the patients and staff who spoke out and demanded that the CQC should come back to the hospital, despite the assurances from the management and the Government that all was well there. They were begging the CQC to return to look again at Whipps Cross, and when we read the report, we can see that they have been vindicated. The lead inspector has rightly expressed his concern that front-line staff will feel even more demoralised following the report, and that their welfare needs to be our priority. What assurances can the Minister give me that, rather than playing party politics, she will listen to the inspectors and heed that warning?

The hon. Lady is quite right to say that patients would be concerned, but they should also be reassured that this inspection regime has exposed some of the issues, and now is the time for them to be addressed adequately. The additional support that the trust will receive as part of the special measures is part of what will help it to make the necessary improvements for patients. The chief inspector of hospitals has highlighted the scale of the challenge ahead, but this is an opportunity to ensure that the trust has the extra support to meet that challenge. That is exactly why the regime exists—[Interruption.] I am sure that, like me, the hon. Lady will have been concerned to read of the culture of bullying and low morale, which is not acceptable. Part of the transparency regime that this Government have put in place involves ensuring that staff can speak out, and I am glad that some of them did. It is never acceptable for staff to feel unable to speak out on the issue of poor care, so I am glad that this report has given them the chance to voice their concerns. Those concerns must now be properly addressed.

The House will be reassured by the Minister’s coming to the House today to make this statement and taking this early opportunity to highlight these issues. [Hon. Members: “What? She was dragged here!”] I am sure you would agree, Mr Speaker, that the Minister stands head and shoulders above those who failed to do anything during their time in office to ensure patient safety.

I thank my hon. Friend for that—[Interruption.] We are hearing a lot of chuntering from a sedentary position, but I refer the right hon. Member for Leigh (Andy Burnham), who asked the urgent question, to a quote from Roger Davidson, former head of media at the CQC, who said in evidence to the Francis inquiry that

“there were conversations between the CQC and ministers to the effect that the CQC would not cause any trouble in the run up to purdah. The message that we don't want bad news infected the whole organisation.”

However much of a small discomfort it might be to Ministers to come and answer an urgent question on such an important matter for patients, people should be reassured that it is far more important that these issues come out transparently, whatever the timing, even if it is ahead of a general election.

Both trusts that serve constituents in the London borough of Redbridge—Barking, Havering and Redbridge, which serves King George hospital in my constituency, and Barts, which serves Whipps Cross—are in special measures. In 2013, the Government forced the closure of maternity services at King George hospital, and as a result some of my constituents had to go to Whipps Cross. I am therefore shocked by what I have seen in the report. It is about time that the Government ruled out their plans to close the A and E at King George, because I do not want constituents of mine dying as a result of inadequate provision in north-east London.

The hon. Gentleman and I have debated these issues in Adjournment debates in this House, so I know that they are of great concern to him. All these issues in that part of London’s health economy need to be considered.

Will Barts be given the same excellent support from the Government as Medway hospital in my constituency, which is in special measures? It has received extra resources and been paired with excellent hospitals such as Guy’s and St Thomas’s. Will the Minister join me in paying tribute to the excellent staff who work day in, day out caring for patients at Medway? Will she also note that in 2006 Medway hospital had the seventh highest mortality rate in the country, yet nothing was done? Will the shadow Health Secretary apologise for that? I welcome the support that the Government have given Medway hospital to turn it around.

I thank my hon. Friend for that question. He illustrates the fact that these problems can be addressed through this regime of extra support. I pay tribute to the staff at his local hospital, who have worked so hard to address the failings and to provide much safer care for their patients. He illustrates exactly why this regime of being transparent about issues and ensuring additional support can be given to trusts to address their problems can be successful and can benefit patients.

I am shocked by the Minister’s tone, as there are genuine concerns about the services that my constituents and those of colleagues are receiving. Barts is the largest trust in England, and when it was formed many concerns were raised. It dilutes accountability and direct line management. Does she agree now that it was too big and that consideration needs to be given to making a number of trusts out of this large trust that are more manageable and directly accountable?

As the hon. Lady knows, the site in question in this report is Whipps Cross. The priority for its management is to address the issues that the CQC has identified.

As my hon. Friend knows, Basildon hospital was one of 14 to go into special measures and one of the first out. I believe that the reason for that is the Government’s openness to accept there are problems and not duck them, the hard work of hospital staff and the open and transparent attitude adopted by the management team to accept the problem and make it their own. Is my hon. Friend confident that the leadership of Barts is willing to accept the problems unreservedly and has the ability to face up to the challenges?

The failings at the site are laid out in black and white in the CQC’s report and it is important that people accept that. There will be intensive support to address that, and the management have already said that they are looking at the problems and have begun to address them. My hon. Friend is right that management and leadership are critical. We have seen that in his area and in others, and that is what those involved must now face up to.

My hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) and I have been assisting the save our surgeries campaign in Tower Hamlets for 18 months, because, like many other GP surgeries in east London, ours are feeling under threat. Today’s response from the Minister indicating that the trust for Barts and the Royal London is in special measures, as well as the Barking, Havering and Redbridge University Hospitals NHS Trust, demonstrates that there is anxiety across east London about the state of the national health service. We did not hear anything in the Budget statement yesterday to give any reassurance to the people of east London. Does the Minister not recognise how serious this is for east London?

This report alone is a very serious report, and of course it is recognised. But it is right that we are transparent about it. As a London MP, I know some of the challenges that parts of the London health economy face. The issues need to be addressed, but this Government have put record amounts into the health service. We are also committed to backing the NHS’s own “Five Year Forward View”, and moving forward new ways of delivering GP care is a part of that vision. We have to make sure that that delivers for the hon. Gentleman’s constituents, as well as for mine and for other people in London.

It is good to know that in his capacity as a distinguished ornament of the Health Committee, the hon. Member for Easington (Grahame M. Morris) takes a keen interest in matters appertaining to east London.

Absolutely, and not least because we warned of these dangers during the passage of the Health and Social Care Bill, which later became an Act. With all due respect, I should point out to the Minister, on her references to openness and transparency, that this failing has happened as a direct result of mergers introduced by this Government. May I respectfully point out that when this merger was approved by the Secretary of State three years ago, Labour MPs, including my hon. Friend the Member for Leyton and Wanstead (John Cryer), did point out that such a change would be a disaster, and that has come to pass? The Secretary of State pressed ahead. May I point out the bullying issues that the report throws up? The chairman of the Unison branch was sacked on trumped-up charges. Will the Minister issue instructions to have those individuals reinstated?

The bullying of NHS staff who are trying to draw attention to poor care is never acceptable, and this Government have taken a lot of measures to make sure that NHS staff are protected. The trust’s chief executive has said the following about the report:

“We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the Trust has a big challenge ahead.”

Part of that big challenge will be in restoring staff morale, and making sure that that culture of openness and support for staff is in place.

The placing of Barts into special measures this week confirms what many of us already know: London hospitals are under enormous pressure, some simply cannot cope and too many patients are not getting the care they deserve. In the light of that, can the Minister confirm that the recently announced Monitor investigation into the Princess Royal hospital at Farnborough will not result in another attempt by her Government to take the axe to Lewisham hospital and to services in south-east London more generally?

I believe we may well be addressing that issue in an Adjournment debate next week. There will be a chance to discuss it in more detail then.

Like my hon. Friend the Member for Easington (Grahame M. Morris), I am not from London, but I do feel qualified to speak on this subject. The issues that have been raised about staff morale and the “down banding” of nurses are all too familiar to me. Until October last year I worked for the NHS—I worked for the NHS for more than 30 years—and what is going on at Barts is very similar to what was going on in the trust in the north-west where I worked. Again, it was a large trust, having been formed by the merger of four hospitals. It is an unworkable plan. As my hon. Friend said, we warned about what was going to happen with the Health and Social Care Bill, and it is depressing to see all this come to fruition. The cost of agency staff, which has been referred to—

Order. May I exhort the hon. Lady to come to a question? I know she has provided her diagnosis, and we are grateful to her for that, but what we need is a question.

My question is regarding the trade unions and the welfare of staff. Staff morale is at an all-time low in the NHS, and trade unions need to be involved in any special measures that are taken in this trust.

The CQC’s inspection report does identify some issues of concern to do with staff morale and bullying. As I said to the hon. Member for Easington (Grahame M. Morris) a moment ago, the issues need to be addressed. We want a culture in which all staff can speak out about poor patient care and feel supported in doing so. That is exactly what we have put in place over recent years.

It has been very disappointing that the Minister, for whom I have a very high regard, has dealt with this disgrace with a crudely political response. Does she not agree that an important element in the recovery of all patients is for them to have faith in their doctors and in the health service? No Government have done more than this one to undermine confidence in the health service throughout the nation. Does she not feel that great damage is being done by making the greatest political achievement of the past 100 years—the national health service—a political football to be knocked about by parties and by undermining that faith in the health service? That is something that the public will not forget and will never forgive.

I do not agree with the hon. Gentleman’s basic premise—not at all. In fact, recently, people’s satisfaction with the NHS has gone up. What he says is a slur on our hard-working clinicians, who respond so magnificently to the pressures in our system. This Government have backed them with money and support. I just do not recognise the picture the hon. Gentleman paints.

Yes, in a moment. I notice that the interest in this debate grew as it was taking place. The First Deputy Chairman of Ways and Means, the hon. Member for Epping Forest (Mrs Laing), and the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) have toddled into the Chamber. [Interruption.] Yes, I understand that the right hon. Gentleman has a constituency interest, and that others have taken a keen interest.

I will now allow a point of order, because it relates directly to the exchanges that have just taken place. I know that the right hon. Member for Leigh (Andy Burnham) will not abuse his privilege.

I am grateful to you, Mr Speaker, for allowing this point of order.

In the Minister’s non-reply to my questions, she inadvertently misled the House. She said that, before the last election, I had blocked a report on Basildon hospital. I wish to place it on the record that I made an oral statement to this House about Basildon hospital and published reports on it on 30 November 2009. I followed that up with a written statement to the House on 5 March 2010. I would be grateful to the Minister if she withdrew her comments.

I note what the shadow Secretary of State has said. He has put it on the record. The Minister is welcome to respond if she wishes, but she is not obliged to.

I was not a Member of the House at that time. Of course I would not wish inadvertently to mislead the House. Nevertheless—[Interruption.] I read out evidence that was given to the Francis inquiry that made it clear that such a culture did exist. However, if, on the specific point, I was not quite right, I will withdraw what I said.