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Southern Health NHS Foundation Trust

Volume 609: debated on Tuesday 3 May 2016

Urgent Question: To ask the Secretary of State to make a statement on the safety of care and services provided by Southern Health NHS Foundation Trust.

I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for her question. At the outset of my response, I want to express my deep concern and apologies to the patients and family members who will again have felt let down by the contents of last week’s report from the Care Quality Commission. Our first duty to patients and their loved ones is to keep them safe. This applies to all of us with a role to play in the NHS, from the frontline to this House, and the Government are therefore clear that it is imperative to be open and transparent about what has gone wrong in order to minimise the risk of similar failings occurring throughout the NHS as a whole. We must ensure that the trust itself continues to be scrutinised and supported to make rapid improvements in care. If that means intervention from the regulators, they will not hesitate to take the necessary action, and we will not hesitate to back them.

Last week’s CQC report followed a focused inspection announced and requested by my right hon. Friend the Secretary of State in December 2015. The report from the CQC set out a number of concerns, including: a lack of robust governance arrangements to investigate incidents; a lack of effective arrangements to identify, record or respond to concerns about patient safety; and a need for immediate action to address safety issues in the trust environment. The report also found that the senior management and board agendas were not driven by the need to address these issues. None of those matters is acceptable.

NHS Improvement has taken action in recent months to address the issues at the trust. It has been working closely with the CQC and the trust, and on 24 March, NHS Improvement appointed an improvement director to the trust. On 14 April, following a CQC warning notice on 6 April, NHS Improvement placed an additional condition on the trust’s licence, asking it to make urgent patient safety improvements to address the issues found by the CQC. That condition gave NHS Improvement the power to make management changes at the trust if it did not make progress on fixing the concerns raised.

On 29 April, following the resignation of the trust chair Mike Petter, NHS Improvement announced its intention to appoint Tim Smart as the chair of the trust. As chair, Mr Smart will have responsibility for looking at the adequacy of the trust’s leadership. Given the centrality of issues of governance to the CQC’s report, I welcome the action taken by NHS Improvement. The direct appointment of a new chair by a regulator is a relatively rare step, and it reflects the seriousness of the issues at the trust. NHS Improvement will continue to monitor the situation closely in the coming weeks and months.

I understand that the CQC is considering the trust’s response to its warning notice, and the risks it highlighted, before deciding whether to take any further enforcement action, and none of its options is closed. The notice required significant improvements to be made by 27 April. Dr Paul Lelliott, the deputy chief inspector at the CQC, was directly responsible for the report, and I spoke to him this afternoon. He informs me that the delivery plan required by 27 April has been received and is in the process of being evaluated. NHS Improvement is working closely with the CQC and the trust, and the improvement director appointed by NHS Improvement is on site regularly, so there is constant independent oversight of the progress being made, as well as the formal monthly progress meetings between NHS Improvement and the trust.

In addition to the action we are taking on Southern Health, it is vital that we learn the wider lessons for the NHS as a whole. First, I hope the whole House can agree that it is right that we have robust, expert-led inspection from an independent CQC that provides an objective view about issues of safety and leadership, and that this is backed with action from NHS Improvement where that is required. Secondly, it is vital that we take the issue of avoidable mortality as seriously for people with learning disabilities and mental health problems as we do for other members of our society. To that end, the learning disability mortality review programme has been put in place by NHS England to ensure that the causes of this inequality are understood, and with the aim of eliminating them. In addition, the CQC will be leading a review of how all deaths are investigated, including those of people with learning disabilities or mental health needs. There can be no question but that the CQC report makes for disturbing reading, and that it demands action at local and national levels. We owe our most vulnerable people care that is safe and secure, and I am determined that we will do all we can to ensure patient safety.

I thank the Minister for very brief advance sight of his response. Patients and parents have a right to be angry at the failure of Southern Health NHS Foundation Trust, and we in this House have a duty to be angry on their behalf. To read the litany of failure, missed warnings, reports and recommendations ignored, and secrecy over the last four years would make any reasonable person angry, too. Friday’s CQC report shows that very little has been done since the House last discussed the matter in December.

The scandal at Southern Health has happened on this Government’s watch, and Ministers must take responsibility for what has happened to some of the most vulnerable people in our country. We should be angry that Connor Sparrowhawk was left to drown in a bath. We should be angry that Angela Smith took her own life. We should be angry that David West died in the care of this NHS trust—his father was repeatedly ignored when he raised his concerns. All of them were denied the care that they so desperately needed. Last week, the BBC reported that over the past five years, 12 patients who had been detained for their safety or that of others have jumped off the roof of a hospital run by this trust. Access to a roof was still permitted to people at risk of suicide. If all those tragic incidents were the only signs of systemic failure, we should be angry, but there is a much bigger story of neglect and malpractice, which aggregates into a major scandal.

When the Secretary of State responded to the urgent question on Southern Health in December, he rightly said:

“More than anything”

people will

“want to know that the NHS learns from”


“tragedies”.—[Official Report, 10 December 2015; Vol. 603, c. 1141.]

The CQC report published on Friday shows that that clearly has not happened. So I ask the Minister: first, what guarantees can the Minister give to the 45,000 patients currently in the care of Southern Health, and their families, that they are safe? Secondly, where is the accountability, the culpability and the responsibility? There seems to be very little. I heard what he said about the chair, but does he agree that the chief executive’s position is now untenable, and that she should be sacked? Thirdly, will he listen to the heartfelt pleas of the victims’ families, the campaigners, and all of us who are demanding a full public inquiry into Southern Health and broader issues, such as the abject failure adequately to investigate preventable deaths?

As the Secretary of State said in December, such issues are not confined to one trust. The Ofsted-style ratings that he previously mentioned will make a difference only if there is proper accountability and the ability to take action to make real improvements to patient care and patient safety. The families have behaved with such dignity and tenacity, and we owe them a debt of gratitude, but it should not be left to them alone to push for accountability.

I listened carefully to what the Minister told the House, but I remain unconvinced that enough has changed. Four months ago, we heard similar reassurances. Today, we are debating the Government’s failure to act. The time for yet more warm words and hollow reassurances is over. We need action, and we need it now.

I thank the hon. Lady for her response. We are not actually debating the Government’s failure to respond at all. The Secretary of State did exactly what he said he was going to do, and the CQC’s inquiry and work that followed can be seen in the report that was produced last week. The report contains a number of further concerns—there is no doubt about that—and people are right to be angry, but there is a process to find out what is going on and to do something about it and that process is in place. That is what NHS Improvement is doing and it is important that that is done.

There is an issue of urgency, which is really important. There are things that are discovered and things take time to get done. I am not content with that in any way, but the process is in place to do something about that. The CQC has been engaged and has ruled out no option for further action. Its options are quite extensive, including prosecution for things that it has found. The process started by the Secretary of State is not yet finished. That my right hon. Friend has demonstrated his commitment to patient safety from the moment he walked into that office cannot be denied by anyone, and this is a further part to that.

I asked the same question that the hon. Lady asked about safety directly to the CQC this afternoon, and I spoke to Dr Paul Lelliott who compiled the report. I asked whether people are safe at the foundation trust today. People are safe because, as we know, the CQC has powers to shut down places immediately if there is a risk to patients. It has not done so, but I am persuaded that if it had found such a risk it would have closed things down. There is therefore no risk to safety in the terms that the hon. Lady suggests.

On the chief executive’s position, the power to deal with management change is held by NHS Improvement. I also offer a brief word of caution. There is a track record of Ministers speaking out, at great cost, about the removal of people in positions over which they have no authority. That is understandable in situations of great concern when an angry response seems right, but it is not an appropriate response. The chair has gone, and processes are available should any more management changes be necessary, which is important. Colleagues in the House can say whatever they like, but a Minister cannot and must say that appropriate processes can be followed, because that is right and proper.

I do not yet know about an inquiry, and I want to wait and see what comes out of the further work being done in the trust. I do not rule out some form of further inquiry, but an inquiry is physically being carried out now by the actions taking place on the ground. What needs to follow is urgent action to respond to what the CQC has said, and a long drawn-out public inquiry is not necessarily the right answer. More work might be necessary, but I need to consider that in relation to further work being done at the trust.

On preventable deaths, as I made clear in my statement, I am sure that not enough attention has been given to those cases that require further investigation across the system, often dating back many years and preceding this Government. We have turned our attention to that issue, and we will make changes because such inequality must end.

The report on Southern Health makes disturbing reading, but we will never tackle unacceptable levels of health inequality and early deaths among those who live with learning disability and mental health issues unless we address safety and risk. Will the Minister go further on the mortality review and set out how we can see where differences exist around the country? Will he reassure the House that duty of candour will in future be more than a tick in the box?

A tick in the box for duty of candour, which the report mentioned, was unacceptable—it must mean much more than that. The learning disability mortality review programme is important and will support local areas to review the deaths of people with learning disabilities, and use that information to help improve services. In time, it will also show at a national level whether things are improving for people with learning disabilities, and whether fewer people are dying from preventable causes. That review is already under way in a pilot in the north-east in Cumbria, which will help to inform us how the programme operates as it is rolled out. Plans are in place to roll out that review across all regions of England between now and 2018, with pilots commencing in other parts of the country between 2016 and 2017. That work has never been done before, and it is right that we are doing it now.

As the Minister and other hon. Members have said, Friday’s report makes grim reading for the many families and patients in the care of Southern Health NHS Foundation Trust. The Minister said that those failings are not isolated to that trust, but are on a much wider scale. In light of that, is he seriously considering a public inquiry that will get to the heart of the underlying factors in those matters? Patients and families who use this trust—some of whom are my constituents—must be reassured that those underlying issues are being properly considered and not brushed under the carpet.

It is vital that they are not brushed under the carpet, and I will come to that in a second. It is important to put it on the record that there are some positive aspects of this report, some of which relate to Southampton. I am sure the hon. Gentleman will already have seen those, with the trust being commended for its work on the community pathway. On the substance of his question, I spoke honestly a moment ago when I said that I really do not know at this stage whether an inquiry is the right thing to do. I am well aware of the seriousness of this matter, of the questions the families have raised, and of the fact that this has been going on for some time. The important thing is both to effect change and to find out what has happened. The CQC report—the extensive work that has already been done—is in depth, public and transparent. That may well have the answers that are required, but if not, something further may be needed, which is why I have an open mind on this. The most important thing is to give the reassurance that certain things have happened, which the CQC report cannot yet do because that is where the work is needed and where the work is going on now.

Our constituents, particularly those with learning disabilities, need to have confidence in the complex set of services provided by Southern Health. The failings that have been identified are completely unacceptable and disturbing, and I welcome the Minister’s statement and the CQC’s action with the warning notice it has issued. Will he join me in paying tribute to the dedicated staff at Southern Health facilities that are not implicated in these serious problems, including Parklands hospital in my constituency, which provides acute wards for adults needing intensive psychiatric care, in a much needed facility that has very dedicated staff running it?

Absolutely. When I got the report over the weekend and turned to the summary of findings, I saw that the first positive summary finding was:

“Staff were kind, caring, and supportive and treated patients with respect and dignity. Patients reported that some staff went the ‘extra mile’.”

It is important to put that on the record; it does not minimise the things that are wrong, but in a trust that is so large, covering such a wide area and so many people, it is important that that good work is recognised, and that errors and faults of management and governance should not be laid at their door. I pay tribute to those staff, who work in incredibly difficult circumstances.

I just note in passing that four Members on the Opposition Benches are standing and none of them hails from the area covered by the trust. That does not preclude a question, but I should just make the point that the question must be about this trust and this set of circumstances, rather than, as is commonly deployed in this House, “and elsewhere”. It is just about this matter, in this situation, covered by this trust—a matter that will be approached with great dexterity, I am sure, by Ann Clwyd.

I will attempt that, Mr Speaker. I just want to ask the following: how long does it take to effect change? Some 45 years ago, the Ely hospital inquiry took place, under the chairmanship of Geoffrey Howe, and recommendations were made. I took part, writing a report on the condition of mental health facilities throughout Wales. We are talking about some 45 years here, and it seems to me that things are going at such a slow pace that we will be asking the same question again in 45 years’ time.

The frustration in the NHS is that although what the right hon. Lady says is not true in some places, it is in others; the special measures process in effect at the moment has effected change and has done so more quickly. There are other places where that does not happen. I am concerned that in mental health the sense of defensiveness which we know has characterised parts of the NHS for too long has probably had too great a grip, and we have not always got things done more quickly or demanded that things are done with the degree of urgency that we would expect, on behalf of constituents. I am very determined that any difficulties in getting things done locally in trusts when they need to be done will not be aided or abetted by any lack of urgency in the Department or the upper reaches of the NHS with which we have contact. The concern to make sure that urgency is there is rightfully expressed by the House, and we have to see that that is delivered.

In 2011 and 2012, I was locked in a bitter confrontation with Southern Health Foundation Trust over the determination of its top management to close no fewer than 58 out of its 165 acute in-patient beds for people suffering from mental health illnesses and breakdowns. It is the only constituency issue over which I have ever suffered sleepless nights, and I failed to stop the trust closing the Winsor ward in the relatively new Woodhaven hospital in my constituency. Today, apart from this terrible issue about the deaths, the system remains overfull, the beds remain too few and I understand that at least 80% of the in-patients are people who have been sectioned, leaving people a very low chance of getting an elective bed from Southern Health unless they are prepared to wait a long time. Can the CQC look into this wider issue, given that it has so many other serious concerns about the trust?

The CQC’s powers are extensive and I know that it will absolutely know what my right hon. Friend says. The debate comparing the provision of beds for treatment with community treatment has been going on for some time in mental health, and different pathways are taken by different trusts. Some trusts put more people into beds, while others are doing more in the community. The general sense is that more should be available in the community, but that must not preclude the availability of emergency beds when they are needed. I will ensure that the CQC is aware of my right hon. Friend’s concerns about that particular trust.

Are the failures at Southern Health a symptom of the growing and unsustainable pressure being placed on the mental health and learning disability services? In the context of increased demand, significant pressure on beds, higher thresholds for care, staffing cuts and shortages, how can the Minister guarantee that mental health and learning disability trusts are able to do their jobs?

Let me point out that we have announced an increased resource for mental health of £11.7 billion. The extra £1 billion that the Mental Health Taskforce recommended being spent by 2020 will be spent, and it will be spent right across the board from perinatal mental health to crisis care. It will also improve baselines to ensure that the governance and quality of foundation trusts are good enough, and we are watching what CQCs are spending. Yes, we recognise that there has been historical underfunding from Governments of all characters, but we are determined to improve it and the money is there.

All too often it is our constituents with mental health problems and learning difficulties who find it hardest to get their voices heard. Those who are patients of Southern Health are not in a position to call for urgent change. I note that the Minister has said that the delivery plan is being evaluated, but can he reassure us that that is being done with the utmost speed so that we see improvements on the ground and not just more reports gathering dust?

Today, I met departmental officials and spoke to the regional director responsible for NHS improvement and, as I mentioned earlier, the deputy chief inspector of the CQC who is responsible for this report. I can assure my hon. Friend that, in so far as it is up to me or the Department, that change will be adequately delivered with a sense of urgency, because, as she rightly says, patients and families have, in some cases, waited much too long for this. If warm words are to mean anything, we must show that delivery follows.

The failure of care for people with mental health issues, learning disabilities and autism has been shocking and the board should go. Equally shocking is the fact that, 11 months before Connor Sparrowhawk’s tragic and unnecessary death, failures had been identified but not acted on. What can the Minister do to ensure that, as part of a robust inspection regime, when failures are identified they are acted on and done so very quickly to prevent such failures again?

Over the past 12 months I have met a number of families who have been victims in similar circumstances—some had children who had been placed badly in an inappropriate place, and, in one or two cases, death had been the result. My colleagues and I are determined to do whatever we can to break down those situations where people feel that they have to fight for everything, and where they find doors closed against them when they want to challenge something. All too often in mental health, when people are challenged, they respond defensively. The whole transforming care process stems from Winterbourne View and the determination of the NHS and the board that monitors and oversees that process, including those who have mental health issues themselves and their advocates. The concerns that have been expressed in the past will not go completely, but I am sure the system is better placed now to deal with them and to listen to people more seriously than was the case, tragically, in the past.

Does the Minister agree that the resignation of the chairman is a measure of the seriousness of the issue, and that after two damning reports, serious changes in the leadership are needed? What reassurance can he provide to my constituents in Fareham, such as the family of David West, that the regulatory bodies have the powers necessary if intervention is required?

I know that my hon. Friend has followed these matters closely for her constituents. Since last year there have been nine changes to the board, and the chair of the board left last weekend. NHS Improvement has the powers to alter governance, and I know from speaking to NHS Improvement that it takes that power and responsibility extremely seriously. The balance is between ensuring continuity and stability so that what the trust has promised is delivered, and wholesale change, which would provide an opportunity for further delay and prevent the work going on, but I know that NHS Improvement is very aware of its responsibilities in relation to governance, as I hope is the trust itself.

It is right that this House legislated for parity of esteem for mental health care; I am proud that we did that. I recognise the Minister’s commitment to quick resolution so that we can implement recommendations to address the failings of the trust. Will he consider an independent inquiry similar to the first independent inquiry into Mid Staffs that my right hon. Friend the Member for Leigh (Andy Burnham) initiated in 2010?

I can do nothing more than repeat what I said earlier. I am aware that there might be circumstances in which an inquiry would bring out more and would demonstrate the degree of concern that colleagues in the House might find appropriate and that the families and others would understand. My first duty is to make sure that everyone is safe in the trust and to ensure the completion of the work that needs to be done to deliver what the CQC has found. Even after this very thorough work by CQC, which is transparent—that is why we are talking about it today—if anything further is needed, I will give it genuine and serious consideration.

The Minister is right to call the report disturbing. It has caused alarm and uncertainty across my constituency, and it is with the uncertainty that I hope he can help. In common with other Members, I am keen to know whether he has a hard date by which the trust is to be reviewed again. If it were to fail that hurdle, what would the next action be—revocation of the licence or further improvements? He will understand that most of my constituents want to see a deadline for compliance, and after that significant change that might mean a new era at Southern Health.

The best way that I can convey it is to say that constant monitoring is being done. First, the improvement director, who was appointed not by the trust, but by NHS Improvement, is there. In due course he will have a constant presence, but the monitoring needs to be done on a very regular basis. Also, the CQC has made it clear that should there be any need for further unannounced inspections, it will carry them out, so the trust is on constant notice that there can be a further inspection at any time. Further powers of the CQC include issuing another warning notice, varying and removing conditions of registration, monetary penalty notice for prescribed offences, suspending registration, cancelling registration, and prosecution. I understand from speaking to Mr Paul Lelliott that none of these measures has been ruled out.

It is that very point I wish to talk about. The duty of candour was going to give us so much more strength, but it is not being applied as yet. It is a statutory duty, placed on people carrying out regulated activities. It can lead to prosecution by the CQC, including without a warning notice. Will the Minister assure me that he will watch carefully to make sure that the CQC uses those powers appropriately? If it does not, we are once again failing these very vulnerable people.

Absolutely. If we now have a system where there is, quite rightly, a degree of autonomy, and Ministers’ responsibility is to make sure that the process and the system work well, Ministers cannot make all the decisions personally, but we do have to make sure that decisions that need to be taken are taken and, if not, that there is a good explanation of why not.

The CQC’s powers have been strengthened. Just a few months ago, we had the first case of a care home owner being jailed because of the care given to people in their home. While I recognise that the work done in caring for vulnerable people is complex and difficult, and that prosecution will not be the right answer in every case, knowing that powers are there is really important. The hon. Lady’s anger is appropriate, and I know the CQC takes these powers very seriously.

Does the NHS improvement director now have the power to go into any Southern Health NHS Foundation Trust facility to assess and neutralise threats we have learned about that have resulted in people dying?

I hope my hon. Friend will forgive me, but I will not say things from the Dispatch Box that I do not know, and I do not know the precise powers of the improvement director, although I know the CQC has exactly the powers my hon. Friend suggests. However, the purpose of appointing the improvement director, and indeed of NHS Improvement’s appointment of the new chair, Tim Smart—the former chief executive of King’s College Hospital NHS Foundation Trust—is to put in place people who know what they are doing, know what they are looking for and can authorise others to make sure that nothing is being covered up and that everything is transparent.

In this sorry saga, what assurances can the Minister give about current levels of care and safety to the families of patients with learning disabilities who are in the care of Southern Health?

I think the best thing, genuinely, is to refer to the CQC report. It highlights good practice and good work in relation to staff in a variety of places and community pathways and in relation to work being done for those with learning disabilities. This is a large trust, covering many areas and many different facilities, and it would be quite wrong to assume that the standard of care is uniform across the board in terms of the criticisms that have been made. The criticisms are very real and very strong, but the work done by individual members of staff caring for people is reported by the CQC to be good. Again, in terms of safety, I am reassured that the CQC has powers and that it has assured me that, if it needed to use those powers in relation to safety and risk to patients, it would do so.

I thank the Minister and other colleagues who have taken part in these exchanges. I content myself simply with the observation that they have been a very important treatment of a very important subject. Perhaps, on behalf of the House, I can express the hope that the Hansard text of these exchanges will be supplied to Southern Health NHS Foundation Trust. It needs to know that we have treated of it and what has been said—politely and with notable restraint, but with very real anxiety—in all parts of the House about the situation within its aegis. [Hon. Members: “Hear, hear!]