§ Mr. Mike O'Brien (North Warwickshire)
Thank you, Mr. Deputy Speaker. Can I confirm the time when the debate will finish?
§ Mr. Nicholas Winterton (in the Chair)
The hon. Gentleman has gained a little time. This debate will not finish until 1.30.
§ Mr. O'Brien
Thank you, Mr. Deputy Speaker. I am very pleased to have that time, as a number of hon. Members wish to speak in this debate, which is important for us. I would like my hon. Friends the Members for Coventry, North-West (Mr. Robinson), for Coventry, South (Mr. Cunningham), for Rugby and Kenilworth (Andy King), for Tamworth (Mr. Jenkins) and for Nuneaton (Mr. Olner) to be able to speak. I understand also that there may be an intervention at some point. I am grateful to the Speaker for granting this debate and to you, Mr. Winterton, for presiding over it. My hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt) is currently attending a sitting of the Select Committee on the Treasury, but has indicated his support for the points that we want to make.
The Government are determined to improve the delivery of health services. As local Members of Parliament, my hon. Friends and I fear that NHS delivery in our area will not improve without substantial changes in the management of the main tertiary and district hospital, the Walsgrave. The running of the hospital has been condemned in a series of reports and statements in recent months. The Commission for Health Improvement—CHI—reported on the Walsgrave in September. It was the worst report ever published by the CHI on any hospital. In October, the NHS league tables designated the Walsgrave as a failing hospital with no stars. A majority of consultants have signed a petition calling for urgent changes in the way in which the hospital is run. Last week, it was reported as having the worst record in the country on heart operations. Members of Parliament have, therefore, taken the unprecedented step of seeking this debate so that we can express publicly our serious concern that the hospital management is a mess and to ask for the resignation of the chief executive, Mr. David Loughton.
I understand that Gary Reay, the chairman of the trust, resigned this morning. It might be said that no man hath greater love than that he should lay down his part-time job for his friend's full-time one. However, Mr. Reay has missed the point—he is not the problem. The problem at Walsgrave has not been caused by the chairman or the board so much as by the dominant influence of a particular individual in the hospital: the chief executive. Apparently, Mr. Reay has also claimed this morning that the only reason why MPs have sought to criticise the chief executive is the proposed site of the new private finance initiative hospital outside the town centre. The truth is that I supported Mr. David Loughton on the PFI hospital and on the new site, but there is a lack of confidence that he can deliver that hospital or improve health care sufficiently in our area.
303WH The CHI report said of the management of the Walsgrave thatsenior staff felt isolated, disempowered and undervalued.The report goes on to state:We were deeply concerned by the number of consultant medical staff who reported feeling bullied, intimidated, threatened and oppressed by senior managers when raising concerns about clinical care or conditions.The CHI found an absence of any strategic leadership on patient care and service issues across the hospital. In particular, it found capacity planning for elective and emergency admissions, development of care pathways and accident and emergency services in disarray. On clinical governance, it found no evidence of any monitoring or review of the organisation as a whole.
There have been a number of other reports, but each time a bad one came out, Mr. David Loughton made reassuring noises, pleading that the report was wrong and that, anyway, he was putting it all right. One report might be in error; two might raise serious questions; but a series of reports says that it is time for a change and that Mr. David Loughton should now go.
There are a lot of excellent staff at the Walsgrave hospital who are doing a great job looking after patients, but they are handicapped by Mr. Loughton's increasingly desperate struggle to hold on to his own job. The hospital needs a new start. There is no confidence in Mr. Loughton: he has presided over the hospital for—what is it?—a decade and had the chance to turn it round but, by his own admission, took his eye off the ball. He now suggests that there is an action plan in place to turn round the hospital as a result of the NHS designating it a failed hospital, and that he should be given a chance to turn it round. It seems to me that if he could not turn it round in a decade, he is unlikely to be able to do so in the next few months.
I say all this not with anger but with sadness. I supported David Loughton on the private finance initiative, but I can no longer support him as manager of the hospital because the problems there seem to be fundamental. A new person is needed to restore confidence and lead the hospital out of its present problems. He has been a dominant personal influence at the hospital, and until that influence is changed we will not get the delivery of quality hospital services that we require.
A lot of good work is done at the hospital, and there are a lot of good staff, as I have said. Many patients will no doubt report that they have been very well treated there, and that will be true because the staff work hard. However, the way in which the hospital has been run has always caused problems and, in those circumstances, we need to restore confidence. We therefore need to have changes at the top.
§ 1.2 pm
§ Mr. Geoffrey Robinson (Coventry, North-West)
I congratulate my hon. Friend the Member for North Warwickshire (Mr. O'Brien) on securing this debate. It is an important debate for those who live in Coventry and in the other constituencies whose MPs strongly associate themselves with what has been said today, because the health of the area is at stake.
304WH As my hon. Friend said, the debate is directly and inescapably about the chief executive, Mr. David Loughton. None of us takes it lightly on ourselves to criticise—let alone call for the resignation of—a chief executive by name, bearing in mind the privileges that we have. Those privileges must be respected all the more because they are unique in what they enable us to do and say in the House. For that reason, I would like to say that in no way does the siting of the new PFI hospital—much though we disagreed on it—have anything to do with the lack of confidence that we now have in the chief executive. It was already evident when we were debating that matter, when we disagreed with Mr. Loughton, that it was impossible to reason with the man, and that he was arrogant and dismissive.
That was a couple of years ago and, far from getting better, things have got worse. We saw that in the case where Mr. Loughton attempted to abuse correspondence between my hon. Friend the Member for Coventry, South (Mr. Cunningham) and one of his constituents, a distinguished consultant surgeon at the hospital. Mr. Loughton tried to use a letter as a reason for suspending, confirming the suspension of, and obtaining the dismissal of that fine, distinguished surgeon. Mr. Loughton would not listen to reason. He went to the high court, then to a higher court still. Each time his arguments were demolished, and each time he had to run away in shame, all at a cost to the long-suffering taxpayers of Coventry of £250,000.
Straight after that came the CHI report, casting disgrace on the management of the hospital. The very thought that one could leave the person who had been in charge for 10 years and brought the hospital to that state of affairs in charge for another three months to turn it round defies any logical analysis. After that, we had the report on coronary bypass surgery. There may be arguments on both sides there, but it is interesting that the hospital should have come bottom of the league in that field—a field that the chief executive had boasted was the jewel in the crown of Walsgrave hospital.
In the light of Mr. Loughton's behaviour in referring in open meetings at the hospital to some of his staff as the five on his hit list whom he is determined to get rid of, naming them, and referring to them using dismissive and abusive language, it is scarcely surprising that the very people that he needs—that any manager would need—to turn round the hospital after 10 years of his mismanagement have passed a vote of no confidence in him. Sixty-six per cent. have said that they have no confidence in him. How could anyone turn round a hospital with 66 per cent. of the staff against him? The hospital has no personnel director, and it cannot recruit a medical director—no one will take on the job—or new consultant surgeons. There is not a grade A consultant in the building, and it would need one to become a teaching hospital.
The whole of the management is dysfunctional. Therefore, any details of a change in the chairmanship of the hospital that the Minister might give us today will be an irrelevance, and cannot be used as a sop to deflect us from the primary objective of obtaining a new chief executive.
If we do not succeed with the Minister today, we shall take the matter to our right hon. Friend the Secretary of State and to the chief executive of the NHS. We shall not let up. If we have to, we shall—in the best of traditions— 305WH call another public meeting in Coventry, at which it will be absolutely clear where the chief executive stands, not in terms of our estimation or our sense of confidence, but in the estimation of the people he is meant to serve. I hope that it will not come to that. I hope that the Minister, the Department and the executive of the NHS will see that this situation can be resolved only by taking the simple step of replacing the chief executive.
§ 1.7 pm
§ Mr. Jim Cunningham (Coventry, South)
My two hon. Friends have covered a lot of what I had to say, so I do not want to cover that ground again. One or two points, however, need emphasising. The staff at Walsgrave hospital do a wonderful job. I was there on Saturday and saw that for myself, and our remarks should in no way be misconstrued as an attack on any of the staff.
This is all about the style of management at the hospital and, in certain instances, the lack of public consultation. For example, the only information that we get on the PFI proposals is what we happen to read in the newspapers. There has been no attempt to bring elected Members in from time to time—we know that these people are busy—to explain to us exactly what is going on. One of the prerequisites for support is to involve not only elected Members but other organisations that might have an interest in the project. That involvement has been sadly absent.
In relation to the chairman's resignation, we never had a quarrel with him. In fact, at times, we had reasonable conversations with him. It became self-evident, however, that he and the trust were unable to control, and therefore to direct, the chief executive. Therein lay the problem. I am also aware that there have been press statements to the effect that we are against the chief executive because we lost the argument over the siting of the new hospital. When that decision was finally made, I accepted that the new hospital would be at Walsgrave, and I have never said anything publicly to suggest anything different. That particular red herring must be disposed of right away.
My hon. Friends and I were willing to assist where we could in developing the new hospital. We were prepared to meet Ministers and to go all the way down the road, because whatever we think about sites and the PFI, the most important thing is that the people of Coventry deserve a new hospital. They have been waiting far too long.
My hon. Friends, and my hon. Friend the Member for North Warwickshire (Mr. O'Brien) in particular, have said that the chief executive had 10 or 12 years in which to turn round the hospital. We appreciate that there were difficulties over the years with lack of resources, but that cannot excuse a lack of good management. As my hon. Friend the Member for Coventry, North-West (Mr. Robinson) said, there were problems between the chief executive, who had a job to do, and the surgeons.
I know that there is friction when talented people are being managed. In fact, everyone here knows that friction is inevitable, and we always recognised that the chief executive had a difficult management task and that he was attempting to secure a new hospital, but the fact that he spent most of the time drafting proposals for a 306WH PFI project and so neglected the hospital and the patients—we all know that waiting lists can result from that—speaks volumes. So, too, does the fact that he could not take a large number of people with him.
According to press reports, the chief executive has the support of most staff. He may well have it, but let me emphasise that what support he has is qualified, as it is being said that staff will give him three months to implement the Commission for Health Improvement report. Then, they may take a different attitude to whether it can be implemented. Like my hon. Friends, I have serious doubts about whether the CHI report can be implemented.
A number of colleagues want to speak, so I end by saying that, in the interests of the people of Coventry and the long-term interests of the staff and the new hospital, the chief executive should think about resigning as soon as possible.
§ Mr. Nicholas Winterton (in the Chair)
Order. Before I call the next speaker, I must point out that four hon. Members want to contribute. The Minister wants 10 minutes to reply, so there are eight minutes for those four hon. Members. If they are disciplined, they will all get in.
§ Andy King (Rugby and Kenilworth)
My hon. Friend the Member for Coventry, North-West (Mr. Robinson) said that, if the worst comes to the worst, we shall hold a public meeting on the issue. I can tell hon. Members and the Minister that there is no building in Rugby big enough to hold the people who would turn out to have Mr. David Loughton removed.
I do not like personalising such issues and I never have, but after almost five years of constant trouble for the residents of Rugby, I have a number of examples to refer to, some to do with basic care and cleanliness, and others of a serious nature which have cost the lives of Rugby people. There is no confidence whatever in Mr. Loughton's leadership of the trust.
The people of Rugby love their local hospital, but they have believed that it has no future ever since Mr. Loughton took over. We have had an uphill struggle. People had to come here with the chief executive and the chairman—who, I am glad to say, fell on his sword—to meet the Minister and secure a commitment on the long-term future of my hospital in Rugby.
We have no confidence whatever in Mr. Loughton's leadership. I shall give a few brief examples. A seriously ill patient who went into Walsgrave wrote to me to say:Floor filthy, appeared mopped with a dirty mop and polish applied sealing in dirt, walls had splashes of what appeared to be vomit or excrement, curtains around the beds stained—corridors actually cleaner than the wards".It is unacceptable that Mr. Loughton allowed the hospital to deteriorate into such a state.
I have other examples of people going into hospital only to end up in a very distressed state. A retired clergyman from my area had to pay for an MRI scan because he was so seriously ill. His biopsies were then lost and the process had to start all over again.
307WH I say to the Minister, please do not try to defend the indefensible. The people of Rugby have asked me to come here to demand that either Mr. Loughton takes the honourable way out and resigns immediately or the Minister removes him.
§ Mr. Brian Jenkins (Tamworth)
I congratulate my hon. Friend the Member for North Warwickshire (Mr. O'Brien) on securing this timely debate, although people may wonder why Tamworth should be involved with a Warwickshire hospital and why the debate is so timely.
I picked up today's edition of The Mirror, which carries a story about a Mr. Ron Cooksey of Tamworth. With regard to the death rate from bypass operations, a letter went out to explain to people, especially Mr. Cooksey, that they should not worry about the reports they have read because they are mere suggestions, but that is a denial of the truth. The letter says:I would like to reassure you that the results in Coventry for non-emergency patients such as yourself are as good as they are anywhere in the country. In fact, over 98 per cent. of patients on our waiting list for coronary heart bypass surgery return home alive and well to enjoy a better quality of life.That is a bit late for Mr. Cooksey. He died 11 months ago.
Mr. Cooksey was put on the priority list in September 2000, but taken off it in October. He died in November. Can Members imagine the distress caused to the family when that letter was received at home? Sending it shows a basic incompetence that I would not tolerate at any level, particularly in the health service. For Mr. Cooksey, the letter was too little, too late. Surely that is not the standard of service that we expect to be delivered in a modern health service.
§ Mr. Bill Olner (Nuneaton)
I, too, thank my hon. Friend the Member for North Warwickshire (Mr. O'Brien) for securing this debate and for giving us some of his time so that we can chip in.
In my constituency of Nuneaton, the Walsgrave hospital is of paramount importance. It is the big hospital to which most people in my area go when they have serious problems. Indeed, a great deal of work goes on between the George Eliot in Nuneaton and the Walsgrave. You, Mr. Winterton, represented north Warwickshire on the county council, so you know those hospitals very well.
I want the Minister to reflect on the letter sent to my right hon. Friend the Secretary of State for Health referring to the Commission for Health Improvement and the fact that the serious problems outlined today are not new. They have existed for seven years, but have not been addressed. Members of Parliament representing their constituents are not the only ones saying that this man should resign. The letter to my right hon. Friend carries three pages of signatures, and consultants and surgeons are saying that, following the CHI report, this man should go.
308WH I hope that the Minister takes heed not only of the letter, but of the arguments we have made today.
§ 1.18 Pm
§ Mrs. Caroline Spelman (Meriden)
I thank the hon. Member for (Mr. O'Brien) for sharing his time with us. I am here to show cross-party support, as this is not a party matter. The constituency of Meriden is also served by Walsgrave hospital, and I wonder how many more of our constituents will have to come to our surgeries with a litany of complaint.
I wrote to the Secretary of State, who replied that steps could not be taken because the current management should be given time to implement its action plan. I put it to the Minister that if the hospital were a school zero-rated by the Office for Standards in Education, it would be on emergency measures and an acting head would be brought in. If I were running a business and 99 of my 159 senior managers signed a letter stating a vote of no confidence in me, I would be left with no alternative. Why should a hospital, especially one where lives are at stake, be any different?
§ The Minister of State, Department of Health (Mr. John Hutton)
I echo the congratulations conveyed by many Members to my hon. Friend the Member for North Warwickshire (Mr. O'Brien) on securing what I think has been, on all counts, an exceptional debate. I have never before witnessed an Adjournment debate in which seven Members wished to participate. There is clearly a strong groundswell of opinion in Warwickshire and Coventry.
I am, of course, aware of the concerns about the standard of services provided by the trust to which my hon. Friends have drawn attention. I realise how strongly they—and the hon. Member for Meriden (Mrs. Spelman) —feel about the need to ensure that good health services are available to their constituents. Those concerns are fully shared by Ministers.
My hon. Friend the Member for North Warwickshire was right to begin by mentioning positive developments in the trust There are such developments: the new renal dialysis unit at St Cross hospital, in the constituency of my hon. Friend the Member for Rugby and Kenilworth (Andy King); the new £1.2 million mobile MRI scanner to serve south Warwickshire general hospitals, the George Eliot hospital and University Hospitals Coventry and Warwickshire NHS trusts. We have been able to invest £6 million in the development of better facilities for linear accelerators.
Coventry and Warwickshire NHS trust has taken a lead as the English national pilot site for colorectal cancer screening, screening people aged 50 to 69 for colorectal cancer to confirm the effectiveness of early detection. It has also recently been accredited as a university teaching hospital. I am grateful to my hon. Friend the Member for North Warwickshire for doing what we should all do—express appreciation for the hard work and commitment of all the hospital's staff and also for their dedication to the well-being of the patients whom they serve.
309WH I am also grateful to my hon. Friend for noting the progress of the new £290 million hospital in Coventry. I agree with my hon. Friend the Member for Coventry, South (Mr. Cunningham) that it is long overdue, but the investment is now being made. The hospital provides a huge opportunity for improvement in the standard of care and treatment available to the constituents of all who are present today. I know that my hon. Friend the Member for North Warwickshire has been a strong advocate of the reforms, and I am grateful to him for that as well.
I shall of course focus my remarks on the concerns raised by my hon. Friends and the hon. Member for Meriden about areas of poor performance. They are substantial concerns, which we take very seriously.
The Commission for Health Improvement's rolling programme of clinical governance reviews began in 2000. The University Hospitals Coventry and Warwickshire NHS trust review began in February this year. During that review, the commission examined the clinical governance structure in the trust, taking account of the views of patients, staff and local partner organisations in health and social care, and user representatives.
As my hon. Friend the Member for North Warwickshire will know, the commission published its findings in September. Its report stated that it hadfound an absence of any strategic leadership on patient care and service issues across the three existing sites. In particular, capacity planning for both elective and emergency admissions and development of care pathways and A and E services are in disarray.Those are exceptionally serious criticisms.
The trust board accepted all the report's findings and, as my hon. Friends will know, has produced a comprehensive two-year plan to address the issues. In the critical period of the first three months, the aim is to end the practice of placing five beds in four-bed bays, rebuild effective working relationships between clinicians and managers—which have been called into question by many who have spoken today—identify the reasons for higher than the national average mortality rates among non-emergency admissions, review the organisation of care between A and E departments to ensure the safe and effective care of patients, and refocus clinical and managerial leadership on the delivery of high-quality services to patients until the opening of the new hospital in 2005. Progress will be measured monthly by the regional office and there will be a joint formal assessment with the Commission for Health Improvement at the end of January 2002.
My hon. Friend mentioned the zero star rating given to the trust in the NHS performance ratings for acute NHS trusts, which were published on 25 September. As he will know, 11 other trusts in England were given the same rating. This is the first time we have assessed performance on issues that parents care about, such as waiting times, hospital cleanliness and the standard of clinical quality, as assessed by the Commission for Health Improvement.
All who spoke raised serious concerns about the trust management's ability to achieve the required improvements. My hon. Friend will appreciate that the positions of the chief executive and other senior managers are, in the first instance, for the trust board to 310WH address and resolve. I do not think that it would be appropriate for me to comment publicly in this debate on whether the chief executive should continue in his post. I hope that my hon. Friend agrees, however, that it would be neither fair nor responsible to local patients, other hospital staff or my hon. Friend's constituents to let poor performance continue without positive and firm action.
I assure my hon. Friends that when the management of a trust has been instructed to embark immediately on plans to improve performance within an agreed time scale and those plans fail to materialise, appropriate action will follow. That may involve a change in the senior management of the hospital concerned, including the chief executive. I have mentioned the trust's action plan to achieve the required improvements, which I think is the right way to deal with my hon. Friends' concerns.
Several Members expressed anxiety about the trust's performance with regard to heart mortality rates, identified as the highest nationally in the recent Dr. Foster publication. It is important to bear it in mind that the trust is a major acute and tertiary referral centre. I understand that, once adjusted to take account of issues such as age and clinical urgency, its figures are not significantly different from those in the rest of the United Kingdom.
§ Mr. Hutton
With the greatest respect, I will not. I have only a few minutes left, and I want to try to deal with all the points that have been raised.
I am told that the hospital has dealt with a higher proportion of surgical cases relating to patients over 75 than hospitals anywhere else in the country, has performed a higher proportion of emergency operations than the average, and has handled more complex cases than a number of other centres. I understand that the trust responded proactively to the publication, trying to reassure patients by, for instance, establishing a patients helpline and sending letters to individual cardiac surgery patients and health care professionals.
The case raised by my hon. Friend the Member for Rugby and Kenilworth is obviously deplorable, as is that raised by my hon. Friend the Member for Tamworth (Mr. Jenkins). I understand that the trust has apologised unreservedly to the family involved, but clearly this should never have happened.
I appreciate the concerns raised by my hon. Friends, especially that expressed by my hon. Friend the Member for Coventry, North-West (Mr. Robinson) about the difficulty of recruiting extra staff to the hospital. He said that it was proving impossible to recruit a medical director. I understand that one has now been appointed, and will start on Monday.
§ Mr. Geoffrey Robinson
The problem is that we are unable to recruit precisely because the chief executive remains in his place. As long as he is there, we shall not regain the confidence that is so vital to the three-month plan. We are now halfway through the plan. Following a vote by consultants, it has emerged that an 311WH unprecedented 66 per cent. are opposed to the chief executive. There is only one way in which to resolve the difficulty.
§ Mr. Hutton
I accept my hon. Friend's point but, although his concerns are obviously serious, it has been possible to appoint a medical director.
§ Mr. Hutton
As I gave way to my hon. Friend the Member for Coventry, North-West, I shall be fair to the hon. Lady and allow her to intervene briefly.
§ Mrs. Spelman
That is kind of the Minister.
The figures in the Dr. Foster study have been adjusted. Having checked, I found that they had been adjusted in respect of both age and inter-hospital transfers.
§ Mr. Hutton
I am sure that the hon. Lady is right. I simply gave the information I have received. I shall make further and better inquiries when I return to my office.
I recognise that the concerns expressed today are very important. Patient safety must be paramount in the national health service at all times and in all places: that is why we have raised the profile of clinical governance in the modern NHS. The concerns need to be addressed quickly by the trust—but there are positive developments as well, and I am grateful to my hon. Friend the Member for North Warwickshire for mentioning them. The task of senior management and the trust board is now to ensure that sustained performance improvements are made as quickly as possible. We will not hesitate to take whatever action is necessary to ensure that that happens.
§ Mr. Nicholas Winterton (in the Chair)
I congratulate all who spoke in the debate on their co-operation. It must be unique for eight Members, including the Minister, to deal with such an important issue in half an hour.