Jeremy Hunt MP is Secretary of State for Health. Follow Jeremy on Twitter.
Normally I find myself in agreement with much written on ConHome but this morning’s analysis from Paul Goodman was unusually wide of the mark. Labour can and will be held accountable for what happened at Mid Staffs. But the time to do it is now, when David Nicholson has given his evidence and we are in full knowledge of what he did – and what was the responsibility of Ministers.
Let me start by saying I agree with Robert Francis that the primary responsibility for what went wrong lies with the board and management of Mid Staffs Hospital. We should not scapegoat individuals outside the hospital for what went wrong. He also said – which I accept – that Ministers at the time were not personally responsible for what happened.
But Labour ministers did make three catastrophic policy mistakes for which they bear direct responsibility – all of which are having a direct impact on the lack of compassionate care in parts of the NHS today.
First, the culture of targets at any cost. I have no doubt it was necessary to introduce some kind of target to reduce waiting times both for elective operations and A & E waits. What was wrong was not to put in any safeguards to prevent poor or weak management blindly following those targets irrespective of the impact on patient care.
Labour’s targets at any cost culture led to a top down, command and control approach where centrally prescribed targets too often became ends in themselves. As David Nicholson described it, “you hit the target but miss the point.”
Warnings about this were suppressed at the time, including in three separate reports from experts in 2008, which were only made public in 2010 after a Freedom of Information request. In fairness, Andy Burnham has accepted that that targets culture under Labour went too far – but there has still been no apology for his government’s total failure to set up proper checks and balances to stop managers going too far and ignoring the interests of patients in the process.
The second big mistake Labour made was in its flawed star rating system for hospitals. This should have been a powerful tool for holding hospitals to account and driving up standards. But Ministers failed to ensure the ratings put patient care and patient experience at their heart. Instead, when the star rating system was introduced in 2000 the way to get more stars was to meet more targets. As David Nicholson said yesterday, under Labour “in the NHS as a whole, patients were not the centre of the way the system operated.”
But when the star ratings system failed, they made their third mistake. Instead of correcting it so that it put patients at the heart of how a hospital is judged, they replaced the Healthcare Commission with the bureaucratic morass which is the current CQC.
In less than a decade we had the Commission for Health Improvement, the Commission for Social Care Inspection, the Mental Health Act Commission, the Healthcare Commission and finally the CQC. Not just 9 reorganisations but 5 different regulators, all with different priorities. Is it any wonder patient care went out of the window?
Labour’s reaction to Mid Staffs has been a deafening silence which is shocking both in its arrogance and complacency. As the Prime Minister said today, David Nicholson has made his apology – it is time for Labour to make theirs. I would go further and say that unless we hear a proper account from Labour, the public will reasonably conclude that similar events could easily happen again if Labour regained power – because the party that used to claim the NHS was safe in its hands is proving by its silence the exact opposite.
Labour now has a choice. It can sit back, relieved that David Nicholson is taking the pressure for ministerial decisions they made which had disastrous consequences. Or it can take the harder course of action and accept that a lack of interest in patients by ministers had appalling consequences and that they are willing to learn the necessary lessons. In the absence of the latter, the public will conclude that Shadow Ministers are more interested in defending their personal records than making the changes the NHS so urgently needs.