Harris and Lamb on Stafford Hospital

5.21.12pm BST (GMT +0100) Sun 5th Apr 2009

• Evan Harris: 'I HAVE come to the debate today . . because I feel both angry and guilty about how, when I was a Front-Bench spokesman, I failed . . to get the point across strongly enough about one aspect of the causes of what happened: the role of targets.'

With that warning ringing in my ear, Miss Begg, I rise to pay tribute to Mr. Kidney for the way in which he has handled himself throughout this whole sad business and for the way in which he introduced the debate. I agree with everything that Mr. Cash said-a rare occasion-and almost all of what Dr. Wright said. I declare an interest in a couple of respects: I am a member of the British Medical Association and on its medical ethics committee, and a vice-president of the Patients Association. My father-this is relevant, as you will hear in a moment, Miss Begg-was professor of child health at Alder Hey before the regime of Professor van Velzen, and in fact appointed him.

I have come to the debate today-I am pleased that the Opposition parties have sent their shadow Secretaries of State to respond, to show how seriously they take it-because I feel both angry and guilty about how, when I was a Front-Bench spokesman, I failed, I guess, to get the point across strongly enough about one aspect of the causes of what happened: the role of targets. I do not claim that that was the only cause, because it was not, but it was clearly contributory.

On page 49 of the Healthcare Commission report, which I shall not read out, there are clear examples of how the operation of targets had an impact on patient care. I do not claim that it is only targets that are the problem; clearly, the way in which the management handled them contributed too. However, there was a fundamental problem with them. I remember a conversation with the hon. Member for Cannock Chase about targets when his Committee was conducting an inquiry, and I thought that its recommendations and conclusions did not quite match some of the fundamental problems.

I am concerned because in a Westminster Hall debate on A and E on 10 September 2003, in a speech devoted entirely to the impact that targets could have on distorting clinical priorities, I said at column 85WH that I had been complaining for six years about the imposition of targets, which worked against the best interest of patients and the health service. I pointed out that the four-hour target for processing people through the department was the wrong measure. On 3 June 2003, as an example, I cited to the then Minister, who is now the Minister of State, Department for Innovation, Universities and Skills, Mr. Lammy, a BMA survey showing that "a majority of respondents in A and E felt that the measures taken"-in relation to targets-"'had distorted clinical priorities . . . and many said that waiting times for patients with the most serious conditions had increased'" and that "'patients were being rushed through A & E, inappropriately admitted, or transferred to the wrong department.'"

It is all here the report. The failure of inspection-the failure of oversight-is a serious matter. There were more deaths in Stafford than in Bristol; there was heartache at Bristol, but no deaths as a result of such shockingly poor practices. Given that there was a public inquiry into what happened in Bristol, there must be a case for holding a public inquiry into what happened at Stafford hospital.

My question to the Minister is this: will one of the inquiries, perhaps that of Professor Alberti, look at the role of targets, the fact that the Government insisted that they had to be met and the way in which they were implemented at Stafford hospital? I believe that the inspectors were unaware that the trust was failing, as it was meeting targets. That reassured everyone. If the Minister were to answer that question, I should be grateful.

. . • Norman Lamb: I, too, congratulate Mr. Kidney on securing the debate. As others have done, I pay tribute to the way in which he has conducted himself and the way in which he has put his case. I agree with everything that he said.

The scandalous litany of failure, which has been going on for so many years, demands an independent public inquiry. Mr. Cash and I called for an inquiry in response to the statement made a couple of weeks ago, and I maintain that view. It is always easy in such cases to find a scapegoat, blame the chief executive, and then move on. It is right that he should be held to account, but it is essential-it is the duty of Government-to ask whether wider questions need to be asked about the causes of such scandalous failures. I therefore have some key questions for the Minister; he can answer them either today or in writing, but they should be considered also by a public inquiry.

First, as Dr. Wright said, what about the role of the clinicians? They were clearly understaffed and under a lot of pressure, but each of them had a duty to their patients. Did any of them speak out at any stage? What happened about the clinicians who were responsible for care in those hospital units? Has action been taken in respect of any of them, or have we quietly moved on? As the hon. Gentleman said, the comments of the British Medical Association are not adequate to address the concerns that have been raised.

Secondly, what about justice for the families who were so badly affected? What consideration has been given, and needs to be given, to how justice can be secured for them? Thirdly, what about the role of the coroner? It is utterly scandalous that the coroner should have obstructed the inquiry. What lessons are to be learned? What will be done to ensure that it never happens again?

My fourth question is about the role of the primary care trust and the strategic health authority. I have a copy of a letter that Sir Ian Kennedy wrote to the Chairman of the Health Select Committee, which I received only yesterday. Sir Ian raises some important questions. First, he says:

"The responsibility for managing performance, including effecting necessary improvements, lay and lies with the trust and its performance manager, the Strategic Health Authority, the commissioning PCT and, after the award of Foundation Trust status, Monitor. These performance managers are able to visit any trust and call for whatever information that they believe is necessary from the Trust to carry out their duties."

What did they do? What visits did they undertake, or was it simply a paper exercise, considering the death rates from afar? That is a central question.

Sir Ian also says: "Following normal practice, efforts were made"- by the Healthcare Commission, as part of its investigation- "to liaise with the trust and the SHA to explore what was needed." What co-operation did it receive? Was the response adequate, particularly that of the strategic health authority? Sir Ian then says: "The investigation team at the Commission did not know that the Trust was being considered for this status"- that is, foundation status; I find that utterly extraordinary- "and was not asked whether there were concerns about the performance of the Trust in terms of the safety and quality of care...We understand that Monitor asked the Strategic Health Authority for its views; the SHA was aware of our work on mortality outliers and 'alerts' by then."

That is scandalous. Why did the strategic health authority remain silent? The allegation is that it was sleeping on the job. That leads us to the chief executive of the SHA, who today takes over the national Care Quality Commission. She must be a player in a fuller investigation of the scandal. As the hon. Member for Stone said, there would be a conflict of interest if the matter was considered in-house rather than independently. That is why independence is so important. Another factor is that her predecessor as chief executive of the then strategic health authority is now chief executive of the NHS.

William Cash (Stone, Conservative): Does the hon. Gentleman not agree that it is so serious that it is impossible to imagine the evidence of the strategic health authority being evaluated in this context in such circumstances? It will be impossible, with such a conflict of interests, to get things right without a public inquiry of the kind that we have called for.

Norman Lamb: I agree.

The fifth critical question, as my hon. Friend Dr. Harris made clear, relates to the role of enforcement of targets-in this case, the four-hour target. Under the heading, "What were the reasons for the failings at the trust?", the Healthcare Commission report says:

"Doctors were moved from treating seriously ill patients to deal with those with more minor ailments, in order to avoid breaching the four-hour waiting time target. Patients were moved to the clinical decision unit to 'stop the clock' but were then not properly monitored, since this area was not staffed."

It beggars belief that the Secretary of State did not mention the four-hour target in his statement, and the bullying culture that pervades the enforcement of such targets.

. . Surely there is a duty on Government to look beyond what happened in that hospital and consider other factors, such as the four-hour target. Wherever I go in the country, I am told by hospital clinicians that, yes, the four-hour target has been beneficial, but I am also told about the bullying culture that surrounds its enforcement. If the Government refuse to consider that, they are failing utterly in their duty. Page 49 of the report shows a graph of when patients leave A and E. Sure enough, there is an enormous spike on the four-hour point, which suggests that people are being shunted out of A and E because the four-hour target has been reached. The Government need to consider that most carefully.

My final question is how on earth can the hospital have possibly cleared all the hurdles to securing foundation trust status, given that the failures had been going on for so long? It had to pass the scrutiny of the primary care trust, the strategic health authority, the Department of Health, the Secretary of State and Monitor to secure it. It shows a tick-box mentality of the same sort that gave Haringey council three stars for its children's service just as the baby P scandal was unfolding. As other hon. Members have said, it has to be the subject of a full independent inquiry. It is scandalous, shocking and horrifying that those failures occurred in a national health service hospital. The NHS is an institution of which we are all proud, but this NHS hospital has badly let down patients in Staffordshire.

There must be a full independent inquiry. Lessons must be learned. Every time one of these awful incidents occurs-I remember the last one, when we were discussing Maidstone hospital-we always say that it must never happen again. Then another incident occurs in a hospital that has been found to have passed through the regulatory process. At some stage, this must come to an end. We must be able to have faith in our NHS hospitals. It is the Government's duty to ensure an independent investigation, to get to the full truth of what happened.

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