NHS Reform — House of Commons, 2015-07-16
Topic: Health
Jeremy Richard Streynsham Hunt (Conservative, Centre-right): With permission, Mr Speaker, I would like to make a statement on measures to improve the safety culture in the NHS and further strengthen its transition to a modern, patient-centric healthcare system. The failings at Mid Staffs, detailed in the Francis report, were not isolated local failures. Facing up to widespread problems with the safety and quality of NHS care and learning the appropriate lessons has been a mission that the Government and the NHS have shared, with a common belief that the best way to deal with problems is to face up to them rather than wish that they did not exist Measures taken in the last Parliament include: introducing the toughest independent inspection regime in the world; more transparency on performance and outcomes than any other major healthcare system; new fundamental standards; a duty of candour; and the excellent recommendations by Sir Robert Francis QC. But because the change we need is essentially cultural, a long journey remains ahead. The Department of Health was described during the Mid Staffs era as a "denial machine". We therefore have much work to do if we are to complete the transformation of the NHS from a closed system to an open one, from one where staff are bullied to one where they are supported, and from one where patients are not ignored but listened to Today I am announcing some important new steps, including: our official response to Sir Robert Francis’s second report, "Freedom to Speak Up"; our response to the Public Administration Select Committee report "Investigating clinical incidents in the NHS"; and our response to the Morecambe Bay investigation. I am also publishing Lord Rose’s report into leadership in the NHS—a key part of the way in which we will prevent tragedies such as these from happening again. I would like to thank everyone involved in writing those reports for their excellent work In his report "Freedom to Speak Up", Sir Robert Francis QC made a number of recommendations to support this cultural change. All NHS trusts will appoint someone whose job is to be there when front-line doctors and nurses need someone to turn to with concerns about patient care that they do not feel able to raise with their immediate line manager. We will also appoint an independent national officer, located at the Care Quality Commission, to make sure that all trusts have proper processes in place to listen to the concerns of staff before they feel the need to become whistleblowers. Other changes will include providing information about raising concerns as part of the training for healthcare professionals and part of the curriculum for medical students, and placing a greater focus on learning from reflective practice in staff development Dr Bill Kirkup’s report into Morecambe Bay brought home to the House that there can be no greater pain than when a parent loses a child and then finds that pain compounded when medical mistakes are covered up. We will accept all the recommendations in this report, including removing the Nursing and Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom, and bringing the regulation of midwives into line with the arrangements for other regulated professions. Likewise, we agree with the vast majority of the recommendations of the excellent PASC report into clinical incident investigations. In particular, we will set up a new independent patient safety investigation service by April 2016, based on the success of the "no blame" approach used by the air accidents investigation branch in the airline industry. It will be housed at Monitor/Trust Development Authority, which have the important responsibility of promulgating a learning culture throughout the NHS. Monitor/TDA will operate under the name "NHS Improvement", and Ed Smith, currently a non-executive board member of NHS England, will become the new chair, with a brief to appoint a new chief executive by the end of September For NHS managers, Lord Rose’s report, "Better leadership for tomorrow", makes vital recommendations to join up the support offered to NHS managers, to improve training and performance management, and reduce bureaucracy. He extended his remit to cover the work of clinical commissioning groups, which play a key role in the NHS, and today I am accepting all 19 of his recommendations in principle, including moving responsibility for the NHS leadership academy from NHS England to Health Education England These are important recommendations, which, in the end, all share one common thread: that the most powerful people in our NHS should not be politicians, managers or even doctors and nurses, but the patients who use it. Using the power of intelligent transparency and new technology, we now have the opportunity to put behind us a service where you get what you are given and move to a modern NHS where what is right for the service is always what is right for the patient A litmus test of that is our approach to weekend services. About 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals. Someone is 15% more likely to die if they are admitted on a Sunday than if they are admitted on a Wednesday. That is unacceptable to doctors as well as patients. In 2003-04, the then Government gave GPs and consultants the right to opt out of out-of-hours and weekend work, at the same time as offering significant pay increases. The result was a Monday-to-Friday culture in many parts of the NHS, with catastrophic consequences for patient safety In our manifesto this year, the Conservative party pledged to put that right as a clinical and moral priority. I am today publishing the observations on seven-day contract reform for directly employed NHS staff in England by the Review Body on Doctors and Dentists Remuneration—the DDRB—and the NHS Pay Review Body. They observe that some trusts are already delivering services across seven days, but this is far from universal. According to the DDRB, a major barrier to wider implementation is the contractual right of consultants to opt out of non-emergency work in the evenings and at weekends, which reduces weekend cover by senior clinical decision makers and puts the sickest patients at unacceptable risk. The DDRB recommends the early removal of the consultant weekend opt-out, so today I am announcing that we intend to negotiate the removal of the consultant opt-out and early implementation of revised terms for new consultants from April 2016. There will now be six weeks to work with British Medical Association union negotiators before a September decision point. We hope to find a negotiated solution but are prepared to impose a new contract if necessary. To further ensure a patient-focused pay system, we will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards, to reward those doctors making the greatest contribution to patient care I am also announcing other measures today to make the NHS more responsive to patients. Those include making sure patients are told about Care Quality Commission quality ratings as well as waiting times before they are referred to hospitals, so that they can make an informed decision about the best place to receive their care. NHS England will also develop plans to expand control to patients over decisions made in maternity, end-of-life care and long-term condition management, which I will report in more detail subsequently to the House. Finally, because the role of technology is so important in strengthening patient power, we must ensure that no NHS patient is left behind in the digital health revolution. I have therefore asked Martha Lane Fox, the former Government digital champion, to develop practical proposals for the NHS National Information Board on how we can ensure increased take-up of new digital innovations in health by those who will benefit from them the most When we first introduced transparency into the system to strengthen the voice of patients, some called it "running down the NHS". Since then, public confidence in the NHS in England has risen 5 percentage points. By contrast, in Wales, which resisted this transparency, a survey has seen public satisfaction fall by 3 percentage points. Over the previous Parliament, the proportion of people who think that the NHS in England is among the best healthcare systems in the world increased by 7 percentage points, the proportion of those who think NHS care is safe increased by 7 percentage points and the proportion of those who think that they are treated with dignity and respect increased by 13 percentage points. That demonstrates beyond doubt the benefits of an open and confident NHS, which is truly focused on learning and continuous improvement As we make progress in this journey, we must never forget the people and the families who have suffered when things have gone wrong. In particular, there are the families and patients at Morecambe Bay and Mid Staffs, the whistleblowers who contributed to Sir Robert Francis’s work, and everyone who has had the courage to come forward in recent years to help reshape the culture of the NHS. Without their bravery and determination, we would not have faced up to the failures of the past or been able to construct a shared vision for the future. We are all massively in their debt. This statement remains their legacy, and I commend it to the House.