Improving the safety culture in the NHS
Health Secretary describes measures taken to improve safety and move the NHS from a closed to an open system.
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 which 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 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 still 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.
So 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 we will prevent these tragedies happening again. I would like to thank everyone involved in writing those reports for their excellent work.
Freedom to Speak Up
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 frontline 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 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 information about raising concerns as part of the training for healthcare professionals and curriculum for medical students, as well as a greater focus on learning from reflective practice in staff development.
Morecambe Bay
Dr Bill Kirkup’s report into Morecambe Bay brought home to this House that there can be no greater pain than for a parent to lose a child and then find that pain compounded when medical mistakes are covered up. We will accept all of 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.
Public Administration Select Committee report into clinical investigations
Likewise, we agree with the vast majority of the recommendations of the excellent Public Administration Select Committee 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 Accident Investigation Branch in the airline industry. It will be housed at Monitor/TDA which has 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.
Rose report
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, performance management and reduce bureaucracy. He extended his remit to cover the work of clinical commissioning groups who 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.
Weekend services
Mr Speaker, these are important recommendations which in the end all share one common thread: the most powerful people in our NHS should not be politicians, managers or even doctors and nurses – they should be 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’ to a modern NHS where what is right for the service is always what is right for the patient.
A litmus test of this is our approach to weekend services.
Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals. You are 15% more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday. This is unacceptable to doctors as well as patients. In 2003/4 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 this right as a clinical and moral priority.
So I am today publishing the observations on 7-day contract reform for directly employed NHS staff in England by the Review Body on Doctors’ and Dentists’ Remuneration and the NHS Pay Review Body.
They observe that some trusts are already delivering services across 7 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 6 weeks to work with BMA union negotiators before a September decision point. We hope we can 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.
Other measures
I am also announcing other measures today to make the NHS more responsive to patients. These include making sure patients are told about CQC quality ratings as well as waiting times before they are referred to hospitals so that they are able to make an informed decision about the most appropriate 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. And, finally, because the role of technology is so important in strengthening patient power, we must ensure no NHS patient is left behind in the digital health revolution.
I have therefore asked Martha Lane-Fox, formerly 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.
Mr Speaker, when we first introduced transparency into the system to strengthen the voice of patients, some called it ‘running down the NHS.’ In fact, 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%. Over the last Parliament the proportion of people who think the NHS in England is among the best healthcare systems in the world increased by 7 percentage points, those who think NHS care is safe increased by 7 percentage points and those who think they are treated with dignity and respect increased by 13 percentage points. This demonstrates beyond doubt the benefits of an open, confident NHS truly focused on learning and continuous improvement.
But as we make progress in this journey we must never forget the families who have suffered when things have gone wrong – in particular 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 nor 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.