Lamb and Harris on the Mid Staffordshire NHS Foundation Trust

• [Mar 18]: ' . . CONDITIONS were described by one relative as being reminiscent of the workhouse, which is a shocking comparison to make. There has clearly been an absolute dereliction of the duty of care, which should shock us all.'

Norman Lamb (North Norfolk) (LD): I thank the Secretary of State for early sight of the statement.

We all recognise the full horror of what has been uncovered in the report-the gross neglect of patients and many dreadful and inhumane examples of poor treatment. Conditions were described by one relative as being reminiscent of the workhouse, which is a shocking comparison to make. There has clearly been an absolute dereliction of the duty of care, which should shock us all. Stafford is not a private hospital, for which we can all blame uncaring shareholders. This is the NHS, and that is what makes it so utterly shocking.

I, too, pay tribute to the relatives who refused to be fobbed off and kept battling away, trying to get justice for their loved ones. It is the Government's absolute responsibility to ensure that we eradicate that sort of experience from the NHS. It must never happen again. In saying that, I am conscious that it was not that long ago that we considered the abject neglect that was found in Maidstone hospital. There are therefore repeated examples of those concerns.

I hope that the Secretary of State will not only focus-rightly-on the culpability of those at the hospital, but face up to the possible wider causes and failures that led to the shocking scandal. So far, we have received an apology from him and the Government only for the failure of others. It is a strictly limited apology and further investigation is required.

The Secretary of State has announced several specific steps that he wants to take, but will he agree to relatives' demands for a full, independent public inquiry into all the possible causes of the scandal and the vital lessons to be learned? Such an inquiry should consider the following matters. First, it should examine the need for justice for patients and relatives who have suffered so much. Secondly, it should consider the rigid operation of the four-hour target and the bullying that too often surrounds it-when one goes to hospitals and talks to emergency care practitioners, one hears that that plays a part. Doctors are told to divert from important care to treat people who are close to the four-hour target, and nurses have been threatened with the sack if the four-hour target is breached. It is extraordinary that the statement did not mention the four-hour target, given that the report refers to it.

It beggars belief that the hospital was a three-star hospital, which secured foundation trust status while all that we have heard was going on. Is that not reminiscent of Haringey council, with its three-star status as the baby p tragedy unfolded? Surely we need a review of the way in which hospitals are assessed in the light of the events. Although managers are rightly in the firing line, what about the clinicians working in emergency care? Clearly, there was appalling understaffing, but did anyone speak out? Should any clinicians be held accountable for what happened? Has anyone left the trust? Has anyone gone through internal procedures? Those questions need answers.

We should also consider the role of the coroner, who failed to provide information about inquests, which would have been helpful. Surely that obstructed the investigation. What about the crucial role of the primary care trust and the strategic health authority? How on earth did matters go on for so long? The high mortality rate dates back to 2003-five full years-before anything was investigated.

What of the role of Cynthia Bower? She was chief executive of the strategic health authority and she is becoming head of the Care Quality Commission. What about her predecessor, who is now chief executive of the NHS? Is there a conflict of interest-

• Mr. Speaker: Order. Obviously, Front-Bench spokesmen get an allocation, but the hon. Gentleman has spoken for four minutes and I must consider Back Benchers and also the fact that there is an Opposition day debate today. If the hon. Gentleman is about to wind up, that is fine, but he is taking liberties at the moment.

• Norman Lamb: I am grateful for that guidance and I will wind up my remarks. The chair of the Healthcare Commission has talked of appalling standards of care and chaotic systems, which are intolerable. Will the Secretary of State instigate a public inquiry? Will he apologise if the conclusion of an independent inquiry shows that the culture of top-down bullying in enforcing rigid targets has played a part in the scandal?

• Alan Johnson: I think that the hon. Gentleman is wrong to call for a public inquiry. We have a very good Healthcare Commission report, which underlines the difference between what has happened and the Bristol royal infirmary inquiry, which considered the position between 1984 and 1995, when there was no commissioner or independent regulator. There was no one to go in and examine the matter and no information. Now, the Healthcare Commission has provided an excellent report. We need to do more-that is why I said that events from 2002 to 2005 need to be examined. We need to be reassured that things are happening now. There needs to be an independent review of case notes and the National Quality Board needs to examine the alerts.

The next stage review, which Lord Ara Darzi leads, appears esoteric in many ways, because it refers to each board having to produce a quality account as well as a financial account and it mentions quality metrics. It is not the stuff that gets people excited, but it is right. When we consider what happened at Stafford, we must move even further. Bruce Keogh, the medical director of the NHS and an eminent cardio-thoracic surgeon, said that there is am"moral, professional and social responsibility" on everyone in the NHS to know "what they are doing and how well they are doing it".

That did not exist previously. The hon. Gentleman spoke about Maidstone, but there was no ability to have such reports previously. The Healthcare Commission's approach has done us proud, and I therefore do not believe that there is a need for a public inquiry.

On what is happening in the trust and whether there is an issue about people on the board or clinicians, I stress that the board, which is now led by a new chair and a new chief executive and has a new clinical director, received the report officially only today. They must now go through due process. I want people to be treated fairly, with due process. The board will consider the report today and decide whether it needs to use internal procedures in the way that the hon. Gentleman suggests.

• Dr. Evan Harris (Oxford, West and Abingdon) (LD): Seven years ago I warned the Secretary of State's predecessors and the hon. Member for Woodspring (Dr. Fox) that these political targets would result in clinical distortions. Does the right hon. Gentleman accept that this hospital was a three-star trust and a foundation hospital under his Government's target metrics? Surely he cannot simply blame the managers, when they were told that they would lose their jobs unless they met the Government's priorities. According to the managers, these were P45 targets, and the Secretary of State cannot simply blame them for what has happened.

• Alan Johnson: What the hon. Gentleman says about targets is stuff and nonsense. There is a debate about this issue. The Royal College of Emergency Medicine and the Royal College of Nursing think that targets are right. They think that the tolerance levels involved should be 95 or 96 per cent., rather than 98 per cent, but to turn Stafford into a technical argument about three percentage points is perverse, and it is unworthy of the report that the Healthcare Commission has produced.

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