Norman Lamb On The Francis Report Into Stafford Hospital

normal_lamb17:16 Tuesday 19th November 2013
BBC Radio Cambridgeshire

[J]EREMY SALLIS: Hospitals in England are being ordered to publish details online every month on how many staff are on each ward. The move, to take effect next year, follows the abuse scandal at Stafford Hospital, where hundreds of patients died from neglect. In addition, the Health Secretary Jeremy Hunt told the Commons that senior medical staff face being struck off for poor treatment, even in cases of near misses. Well I asked our political reporter Matt Cole to explain the terrible incidents at Stafford Hospital that led to today’s announcement.
MATT COLE: Indeed, there were some serious serious failings that led to the deaths of many many people between 2005 and 2008 at Stafford Hospital. Robert Francis QC was brought in. He did a number of reports. This second one though wasn’t so much specifically just about Stafford Hospital. It therefore expanded a little into thinking about the wider issues of care. Now there were some 290 recommendations made when that report was published earlier in the year. Today Jeremy Hunt the Secretary of State for Health said that he accepted, in principle at least, all 290, in fact 281 actually fully accepted, and 9 not, but the substance behind them was accepted. He just said in the Commons today that things had gone so badly wrong at Stafford Hospital they didn’t want them to happen again.

JEREMY HUNT: One of the most chilling accounts in the Francis Report came from Mid Staffs employees who considered the care they saw to be normal. Cruelty became normal in our NHS, and no-one noticed.
MATT COLE: Now Jeremy Hunt says he doesn’t just want to improve the NHS, he wants to make it a beacon of excellence across the world.
JEREMY SALLIS: So just run us through a few of the changes Matt.
MATT COLE: Quite a lot, so I’ll rattle through a few of the top lines. There’ll be quarterly reports now of complaints in hospitals, and how they’re handled will have to be explained, and patients and families will have to have clear information on how they can complain. The name of the consultant and nurse responsible for patients’ care will have to be above their beds. Bad managers will be banned from taking a new job. There will be a criminal offence of wilful neglect to hold staff to account. And there’ll be this monthly reporting of staffing numbers on wards. Hospitals will have to establish how many people there should be on each ward, and then they will have to report whether they’re managing that. That will go on to a website (so) that everyone can see that they’re making those numbers, and if they’re hitting those targets.
JEREMY SALLIS: Just to be clear then, hospitals will have to publish how many nurses are on each ward. But will there have to be a minimum legal number on duty?
MATT COLE: No. And that’s something actually that Cure The NHS, that’s the organisation, Julie Bailey, one of the people who was the driving force behind exposing what was going on at Stafford Hospital, she says she wanted to see out of all this a minimum number set nationally for how many people should be on wards. Now Jeremy Hunt’s people and actually the BMA, the British Medical Association, both say that wouldn’t really be possible, because of the different ways that different wards operate. And also you’d have a situation whereby if a hospital suddenly couldn’t meet that minimum target would the ward then be closed? And if so, that would create a whole new range of problems in care. So that won’t be happening. But there will at least be now a way of holding hospitals to account by seeing they’re not hitting their targets. And that way people will start asking questions.
JEREMY SALLIS: Our Political Correspondent Matt Cole speaking to me earlier. Well historically nursing has been one of those jobs associated with long hours and poor pay. Perhaps not surprisingly then there’s been a real shortage of nurses in Cambridgeshire here over the past few years. Well just three months ago our reporter Jozef Hall took an in depth look at the challenges facing our nurses, and our hospitals. He joins me now. Evening to you Jozef.
JOZEF HALL: Good evening Jeremy.
JEREMY SALLIS: Remind us exactly what you discovered.
JOZEF HALL: Well in a nutshell were and still are short of nurses. Over the past two years over 1,000 nursing positions have been cut here just in the East alone. And that’s put huge huge weight of responsibility on various hospitals. I remember three months ago doing this report. One hospital not too far from here had to fill over 120 shifts in one single weekend Jeremy. So not enough nurses to go round.
JEREMY SALLIS: What were the main problems as a result of those challenges?
JOZEF HALL: Simply finding staff to fill the shifts. They need to be filled. You’ve got ill, sick people here. Hospitals were having to buy in agency nurses, which costs a lot more than regular nurses. And they’re just having to ask too much of their nurses who are already on duty. Now I spoke to two nurses in particular, one from Addenbrookes here in Cambridge, the other one from Peterborougth Hospital. Neither of them wanted to be named. They wanted to stay anonymous. But they were both very very keen to speak out about some of the pressures they’d been put under.
NURSE: My phone, whenever it buzzes, I know it’ll be the NHS. Wards are pushed to the limit, and they’re calling out for people to come and help them. You used to get maybe one, two texts a day with three or four jobs available. But now it’s five or six texts a day if not more, up until ten o’clock at night. It’s constant.
JEREMY SALLIS: Well presumably they’re not being forced into doing extra shifts.
JOZEF HALL: Well not being forced, or in a way they are. They told me that they do this job, they’re nurses because they want to look after people. They feel a responsibility to look after people. And as such, it wasn’t very difficult they said to feel guilty if they weren’t covering shifts.
NURSE: If you say no, someone’s got to pick it up.
NURSE TWO: It pulls on your emotional side. Guys, there’s three nurses available on Saturday. Is there anybody here who feels they can just push it a little bit harder and do another shift.
JOZEF HALL: Bit of a Catch 22 then Jeremy. Nurses are exhausted. their morale goes down. And of course, lo and behold, less people want to be nurses. On a practical level of course, having overworked nurses in a ward can of course be dangerous.
NURSE: There are times where you think you’re able to cope with something, but when it gets to that breaking point, you can’t, and you flake out, and you become ill or whatever.
NURSE TWO: People are doing a shift and a half extra, if not more, a week, to cover the short staffing.
NURSE: There’s a lot of members of staff offered a little bit extra to do an extra shift, and they may take it, because they may be desperate for that shift.
JOZEF HALL: And what are the potential downfalls there?
NURSE: That they themselves could become sick. And then you have also the patients, they’re going to suffer from it as well.
JOZEF HALL: So they’re being put at risk, in danger?
NURSE: Potentially. Yes.
JEREMY SALLIS: So several months on from your in-depth report there, have things improved?
JOZEF HALL: Well I haven’t spoken to any nurses about their morale, so I don’t know about that. But I have had a chance to talk to our two main hospitals today, Peterborough and Addenbrookes. Now Peterborough having another nurse recruitment day coming up in just a few weeks time. That’s a special recruitment day for experienced nurses only. They’ll be saying we’ve got a brand spanking new hospital. It’s a great place to come and work. They’re hoping that’s going to ease a bit of the pressure. And at Addenbrookes they’ve got an ongoing recruitment drive. When I spoke to them those three months ago, they needed to fill about 200 posts. They’ve still got 120 posts up for grabs. So in theory some of the pressure should be eased on the nurses, and as whole, the system.
JEREMY SALLIS: Jozef, thank you very much. Our reporter here at BBC Radio Cambridgeshire, Jozef Hall. Now, Norman Lamb is the Care and Support Minister for the Coalition Government. I spoke to him before the programme, and asked him if the Government had been forced into taking action today by the likes of Julie Bailey, who lost her mother in terrible circumstances at Stafford Hospital.
NORMAN LAMB: No I don’t think so at all. First of all I’ve paid absolute tribute to Julie Bailey, and several others who campaigned tirelessly to get listened to and to get changes that were absolutely necessary. But certainly when we received the Robert Francis report last year, last Autumn, Jeremy Hunt and myself, and this is in a sense the Coalition in action, and it’s been a completely united reaction to it, and we’ve worked I think very effectively together and we’ve been absolutely clear that culture that Robert Francis talked about had to change; that we had to put patients first; that we have to create an open culture, where nothing is hidden from view; that we have very clear accountability when things go wrong; that people are held to account at the top of organisations when there are failures. And also that there is in a sense an obsessive focus on safety, on safe good quality patient care.
JEREMY SALLIS: But why did it take the Francis Enquiry? Why did it take the likes of Julie Bailey to make this clear to you as a government? Nurses have been saying this for years. If they don’t have the staff, their patients’ lives are put at risk.
NORMAN LAMB: Well I’m actually very proud of the fact that it’s this Government that is getting to grips with this, and responding to a report that .. I mean Robert Francis’ work I think is exceptional. I think this is actually an extraordinarily significant moment for the NHS. I for one, very similar to most people in this country, am immensely proud of our NHS. But I think those of us who hold the NHS dear have to also recognise that where things have gone wrong, as they have done in places, we can’t shy away from challenging those failures and from getting it right. And this Government, this Coalition Government, and myself as a LibDem Minister, we’ve been completely focused on opening the whole system up.
JEREMY SALLIS: But I say again, a Coalition Government which came into power in 2010, nurses were saying at that point if they didn’t have the staffing levels, lives were at risk. That does sound like a very long time to react to this situation.
NORMAN LAMB: Well I think we .. first of all we had to get the Francis Report. We appointed Robert Francis to conduct the public inquiry. We recognised that that had to happen. And we got the report earlier this year. And as soon as we got it we set to work on implementing his recommendations. And I think there has been no delay at all. An awful lot of good things have happened in the NHS in the last three years, but we had to get Robert Francis’ analysis of the problems, and then critically react speedily to them. And that’s I think exactly what we’ve done.
JEREMY SALLIS: Good things. Does that include the fact that as Labour pointed out today, there’s 6,000 fewer nurses in the NHS than when the Coalition came into power in 2010.
NORMAN LAMB: Well in fact if you look at the figures overall there’s a very significant reduction in administrative staff, over 20,000 fewer administrative staff including vast numbers of managers that were appointed during the Labour years in office. But also actually over 4,000 more clinical staff. So more doctors, more midwives, and although there was a dip in nursing numbers, what’s very interesting is that there are plans now in place for I think 3,700 new nurses. There are more nurses now incidentally working in critical care than there were three years ago. And I think the nurse to bed ratio is better than it ever has been. But nonetheless, the pressures are intense. There are more people turning up in hospital with dementia, frail elderly people turning up. And one of the things that we have to do better is to keep people out of hospital where hospital admission is avoidable. There are too many cases where there have been in a sense failures of care in nursing homes or care homes, or in people’s own homes. And I think if we can do better at preventing a deterioration of health, then we can ease pressure on hospitals.
JEREMY SALLIS: Norman Lamb, speaking to me just moments before the show.