On Wednesday, the Prime Minister made a statement to the House of Commons about the Francis inquiry into Mid Staffordshire NHS Foundation Trust. I'd encourage you to read the whole thing here - it's incredibly powerful - but if you're short of time what follows is a precis of what he had to say with some comments about its relevance to our local hospital.
Like the Prime Minister, I have reason to be personally grateful to the NHS - it saved my life when I had cancer as a child. And beyond that personal gratitude, I think the principle that underpins the NHS - that if you have an accident or are unwell, you can access medical treatment without having to worry if you can afford to pay for it - is one of the building blocks of a decent society.
But that doesn't mean the NHS should be immune from criticism when things go wrong. And it's clear that things went badly wrong at Mid Staffordshire between 2005 and 2009. Hundreds of people suffered from the most appalling neglect and mistreatment. There were patients so desperate for water that they were drinking from dirty flower vases. Others were given the wrong medication, treated roughly or left to wet themselves and then lie in urine for days. Relatives were ignored or even criticised when they complained. How did this happen and how was it allowed to continue for so long? Why didn't the Primary Care Trust (PCT), the Strategic Health Authority (SHA), the regulators and/or the Department of Health spot what was going on and do something about it? It was to answer these questions that the Francis inquiry was established.
It has found that the appalling care at Mid Staffordshire was primarily the result of a “serious failure” on the part of the hospital board but that the failure went far wider. The PCT assumed others were taking responsibility and so made little attempt to collect proper information on the quality of care. The SHA was “far too remote from the patients it was there to serve and it failed to be sufficiently sensitive to signs that patients might be at risk.” Regulators - Monitor and the then Healthcare Commission - failed to protect patients. The Royal College of Nursing was “ineffective both as a professional representative organisation and as a trade union” and the Department of Health was too remote. These systemic failures raise concerns about whether there have been similar failings of care at other hospitals and about the culture within the NHS.
Some changes have been made since 2099. The last Government set up the National Quality Board and the quality accounts system. This Government has put quality of care on a par with quality of treatment, setting this out explicitly in the mandate to the NHS Commissioning Board. It has demanded nursing rounds every hour in every ward of every hospital. And it has introduced a new programme for tracking and eliminating falls, pressure sores and hospital infections - we should not accept that these things are somehow occupational hazards in hospitals, that they are inevitable and therefore okay. They are not okay.
But it is clear from the Francis inquiry report that we need to do more. The report makes 290 recommendations. The Government will respond in detail next month, but the Prime Minister mentioned three areas - more focus on patient care and less on finance and top-down targets; more accountability; and less complacency - on which he wants to make immediate progress.
First, patient care. At the moment, when a hospital fails financially its chair can be dismissed and the board suspended, but failures in care rarely carry such consequences. That can't be right. So the Government will create a single failure regime, where the suspension of a board can be triggered by failures in care as well as failures in finance.
It will also put the voice of patients and staff at the heart of the NHS. In Mid Staffordshire, there was a staff survey in 2006 in which only around a quarter of staff said they would want one of their own relatives to be treated at the hospital. This is surely the best measure of how a hospital is performing. So from this year, every patient, every carer and every member of staff will be given the opportunity to say whether they would recommend treatment at that hospital to their friends or family. The results will be published and the board will be held to account for its response. Where a significant proportion of patients or staff raise serious concerns, the hospital will be inspected immediately and the board may well then be suspended.
At the moment, it is possible to give hands-on care in a hospital with no training at all. This too is clearly wrong. There are some other simple but quite profound things that need to change in our NHS. Nurses should be hired and promoted on the basis of having compassion as a vocation, not just academic qualifications. And pay should be linked to quality of care rather than just time served at a hospital.
Second, more accountability. An earlier report set out very clearly what had happened at Stafford hospital. It should have led to those responsible being brought to book by the board, by the regulators, by the professional bodies and by the courts. We expect hospitals to take disciplinary action against staff who abuse their patients. We expect the professional bodies to strike off doctors and nurses who seriously breach their professional codes. And we expect the justice system to prosecute those suspected of criminal acts. But that did not happen. The Government has asked the Nursing and Midwifery Council and the General Medical Council to explain what steps they will take to strengthen their systems of accountability. It is also looking at transferring the right to conduct criminal prosecutions of hospitals from the Health and Safety Executive,whose main focus is never going to be on healthcare, to the Care Quality Commission.
Third, less complacency. We must stop turning a blind eye to problems. That means handling complaints better. But it also means having someone make public, explicit judgements about how clean, safe and caring our hospitals are. My constituents know which schools near them are outstanding and which are failing. That's because when it comes to schools we have an inspectorate that makes judgements not just on the basis of performance against numerical targets but on independent experts who observe lessons, walk the corridors of the school and then publish their findings. We need the same when it comes to hospitals. So the Prime Minister has asked the Care Quality Commission to create a new post, a chief inspector of hospitals to take personal responsibility for that task.
I'm delighted that the Prime Minister has focused on this issue of quality of care. In the first two and a half years of this Government, the arguments have all been about how the NHS is structured. I accept that you need to reform structures to get more of a focus on what patients want. But when my constituents talk to me about the NHS, it is the quality of care they talk about. Most are satisfied with the quality of treatment they get at Croydon University Hospital, but many are not happy with the personal care that goes with it. And Croydon is one of the worst performing hospitals in London on the key test I referred to earlier - the proportion of staff who say that they would want one of their relatives to be treated at the hospital. If the Prime Minister can find a way to translate his evident passion on Wednesday into real change on our wards, if he can support the many passionate people who work in our NHS and want it to provide better care, then it will be one of this Government's greatest achievements.