Independent Review of Liverpool Community Health NHS Trust

 

Parliament logo     www.parliament.uk   House of Commons Hansard

Acute and Community Health   8 Feb 2018

12.34pm

    • With permission, Mr Speaker, I wish to make a statement on the independent review of Liverpool Community Health NHS Trust, which was conducted for NHS Improvement by Dr Bill Kirkup and published today.

      What happened to patients of Liverpool Community Health NHS Trust is, before anything else, a terrible personal tragedy for all families involved, and the report also makes clear the devastating impact on many frontline staff. On behalf of the Government I apologise to them, and I know that the whole House will want to extend our sympathies to every one of them.

      As Mr Speaker correctly identified, I wish to pay tribute to the hon. Member for West Lancashire (Rosie Cooper). The people of Merseyside know only too well the cost of attempting to silence the victims and campaigners for those seeking justice. As the report makes clear, her personal commitment to get to the truth on behalf of the victims of Liverpool Community Health NHS Trust, her personal courage in asking difficult questions of those in senior positions within the NHS, and the persistence and precision of her search for accountability, are all vindicated today. We in this House, and across the wider health and social care services, owe her a debt. I also thank Dr Kirkup and his team for this excellent report. As with his report on Morecambe Bay NHS Foundation Trust, it is a clear, forensic, and at times devastating account of failures in the care of Liverpool Community Trust by its management, its board, and its regulators.

      The report covers the period from the trust’s formation in November 2010 to December 2014, and it describes an organisation that was, “dysfunctional from the outset”. The consequences of that for patient care were in some cases appalling, and the report details a number of incidents of patient harm including pressure sores, falls leading to fractured hips, and five “never events” in the dental service—an incredibly high number for one organisation.

      The failings of the organisation were perhaps most starkly apparent in the services provided at Liverpool Prison, where the trust failed to properly risk-assess patients, including for nutrition and hydration, and it did not effectively manage patients at high risk of suicide. The review also identified serious failings in medicine management at the prison. There are many more examples of poor care and its impact on both patients and staff in the report, but what compounds the shock is the lack of insight into those failings displayed by the organisation at the time. This was the very opposite of a culture of learning, with incidents under-reported or played down, warning signals ignored, and other priorities allowed to take the place of patient safety and care for the vulnerable.

      We have seen this sort of moral drift before, most obviously at Mid Staffordshire and Morecambe Bay. As with Mid Staffordshire, the management at Liverpool Community Health NHS Trust put far too much emphasis on achieving foundation trust status. The review states that,

      “the trust undertook an aggressive cost improvement plan, targeting a £30 million reduction over five years. This represented a cut in resources of approximately 22%. We were surprised that such an ambitious financial reduction was not scrutinised more closely—by both commissioners and regulators.”

      There is a direct line from the decision to pursue foundation trust status in that reckless manner to the harm experienced by patients. Indeed, an earlier report by solicitors Capsticks reported in March 2016 that the interim chief executive who took over from Bernie Cuthel found in her first week that

      “there was an underspending by £3 million on district nursing. These teams were devastated because they weren’t allowed to recruit, some of them down to 50%”.

      This is a district nursing service in which Dr Kirkup reports that patients were experiencing severe pressure sores, up to what is clinically called grade 3. That was accompanied by many of the hallmarks of an organisation that has lost sight of its purpose. As Dr Kirkup states,

      “the evidence that we heard and saw amply confirmed the existence of a bullying culture within the Trust, focused almost entirely on achieving Foundation Trust status. Inadequate staffing levels, poor staff morale and appalling HR practice went unheeded. This was the end result of inexperienced leadership that was not capable of rising to the challenges presented by the Trust.”

      Following the Mid Staffordshire report, Dr Kirkup recognises that steps have been taken to introduce independent, clinically-led inspection by the Care Quality Commission. The Government have also introduced the special measures regime within NHS Improvement. Alongside this, we have put in place a number of measures to create a wider culture of learning and improvement. The Secretary of State has offered a great deal of personal leadership in helping to create this culture, including the establishment of an independent chief inspector for hospitals, whom I met yesterday and spoke with again this morning, and the recent introduction of measures to support trusts to learn from deaths and to improve patient safety.

      I am sure I am not alone in finding it astonishing that Dr Kirkup found there was a

      “small minority of individuals who refused to co-operate”

      with the review. I wholeheartedly agree with his view that

      “it remains the duty of all NHS staff to assist as fully as they are able with investigations and reviews that are directed toward improving future services”.

      All but one of the board of the Liverpool trust shirked their legal and moral responsibility to be candid about the organisation they governed. In large, complex organisations, responsibility and accountability are always distributed to some degree. It is the case that the higher up in an organisation someone is, the greater their degree of responsibility. In this case those individuals were Bernie Cuthel as chief executive and Frances Molloy as chair. It is clear from reading the report that they each must take a significant share of the responsibility for these failures.

      Hon. Members will, I am sure, have noted the conclusion to the clinical governance section of the report, which highlights the responsibility of the former chief executive of the trust for the system of clinical governance and its failures. It would appear from the report that while the former chief executive, Ms Cuthel, is now able to see that there were failures in clinical governance, she does not have as strong a sense of her own responsibility as one might expect. I understand that she is no longer employed in the NHS in England, but she does continue to hold a role working with the NHS in Wales.

      In response to this report, the Government intend to take a number of actions. First, the Government accept the recommendations in full. While this was a report commissioned by NHS Improvement, I will write to all the organisations named in the recommendations set out at section six of the report, asking them to confirm what steps they will take to implement the recommendations, or to set out their reasons for not doing so. I will ensure copies of that response are shared with the Health Committee.

      Secondly, one recommendation is specifically for the Department of Health and Social Care, as set out in paragraph 6.5 on page 64. This relates to a review of CQC’s fit and proper person test. I intend to discuss the terms of that review with the hon. Member for West Lancashire and will appoint someone to undertake that review within the coming days. I believe that review will need to address the operation and purpose of the fit and proper test, including but not limited to: where an individual moves to the NHS in another part of the United Kingdom; where they leave but subsequently provide healthcare services to the NHS from another healthcare role, such as with a charity or a healthcare company; where differing levels of professional regulation apply, such as a chief executive who is a clinician compared to one who is a non-clinician; where there is a failure to co-operate with a review of this nature and what the consequences of that should be; and reviewing the effectiveness of such investigations themselves when they are conducted. I will be pleased to hear the views of the hon. Member for West Lancashire, and those of the Health Committee, on these issues.

      Thirdly, I have asked the Department to review the effectiveness of sanctions where records go missing in a trust, or where records appear to have been destroyed.

      Fourthly, I have asked the Department for advice on what disciplinary action could be taken against individuals in relation to the findings of this report. Clearly due process needs to be followed, but it is important that we address a revolving door culture that has existed in parts of the NHS, where individuals move to other NHS bodies, often facilitated by those who are tasked with regulating them.

      Fifthly, I will ask NHS Improvement and NHS England to clarify the circumstances under which roles were found or facilitated for individuals identified in the report as bearing some responsibility for the issues at the trust.

      Finally, I have spoken with colleagues at the Ministry of Justice and confirm to the House that they intend to investigate the issues arising from this report in respect of HMP Liverpool specifically and the prison estate more generally.

      All organisations and individuals make mistakes. Where this is used as an opportunity to learn and improve, we will do all we can to provide support. Where, however, there is any kind of cover-up or a blinkered denial of what has happened, Members of this House and the victims of that wrongdoing have a right to expect accountability. The hon. Member for West Lancashire has done the NHS a great service. I will place a copy of the Kirkup review in the House of Commons Library. The Government are acting in full on the findings of the report.

       
       

    • May I start by adding my appreciation for the tenacity my hon. Friend the Member for West Lancashire (Rosie Cooper) has shown in pursuing this matter over a number of years? She has led the way in tackling this injustice fearlessly and relentlessly. In that respect, she is an example to all right hon. and hon. Members in this place. I agree with the Minister that the report is a vindication of her courage, but is it not shameful that this scandal only came to light because a Member of Parliament was prepared to give a voice to those who were afraid to speak out?

      Today’s independent report on the Liverpool Community Health Trust lays bare a catalogue of failure that caused harm to patients across Merseyside between 2010 and 2014. It is a grim example of a repeat of the regulatory pressures and board management failures at Mid Staffs. What is of huge concern is that some of the failures came after the final publication of the Francis report. As we have heard, incidents identified in the report include the deaths of inmates at HMP Liverpool, patients having the wrong tooth extracted by trust dentists, and patients on intermediate care wards suffering repeated falls and broken bones or ending up with pressure ulcers. We have to make sure that the pain experienced by so many patients and their families is properly detailed and recognised. We must make sure the NHS is able to learn from these events and that systems are put in place to ensure they never happen again.

      I put on record our thanks from the Labour Benches to Dr Bill Kirkup and his team for the work they have done in carrying out this investigation and helping us to understand what has gone wrong. Today’s report says that patients of community services suffered unnecessary harm because the senior leadership team was “out of its depth”. Let us be clear what lies at the heart of this: unrealistic cost-cutting by the trust without regard to the consequences that led directly to patients being harmed. The report exposes serious problems around the scale of cost-cutting being imposed on NHS trusts. In the case of Liverpool Community Health, the motivation was the drive to achieve foundation trust status. The trust disciplined and suspended staff who blew the whistle about poor care and its controversial plans to slash staff to save money. What guarantee can the Minister offer that trusts are no longer being allowed to prioritise financial savings over patient care? What protections have been put in place for staff who raise concerns about cost-cutting?

      Today’s report notes the irony of staff reductions being agreed at the same board meeting that had earlier considered the implications of the Francis report. That alone should have raised alarm bells about the capacity of board members to challenge the trust. The NHS still faces huge workforce shortages, so what update can the Minister give us on how the 10-year workforce strategy has been received? What additional measures will the strategy include to guarantee safe levels of staffing in all areas of the country, in community as well as acute services?

      I am pleased that the Minister recognises concerns that managers responsible for these extreme failures can often go into leadership roles in other parts of the health service, or indeed for private providers to the NHS in another capacity. Will he advise the House how many people who refused to co-operate with the investigation are still employed in some part of the NHS? Is there anything in the existing terms and conditions or structures that can be used to require future co-operation? Is there any redress in existing policies and procedures that we can use against these people?

      The report said that regulators were distracted by higher-profile services such as acute care. The Health Service Journal said today that oversight failures were partly attributable to organisational changes that were taking place under the Health and Social Care Act 2012, so what will the Government do to ensure that national priorities are not allowed to interfere with local oversight?

      Finally, the report raises serious concerns about the quality of healthcare in prisons. HMP Liverpool still has significant challenges, and the new provider of the prison’s health service—the Lancashire Care NHS Foundation Trust—has just said that it cannot continue with the contract on the level of funding currently available. The Ministry of Justice will investigate these matters more generally, but will the Minister assure us that prison healthcare is properly supported and resourced in Merseyside and elsewhere across the country?

      Paragraph 1 of the review’s findings sums up the devastating impact of these multiple failings:

      “Staff were overstretched, demoralised and—in some instances—bullied. Significant unnecessary harm occurred to patients.”

      In the unprecedented financial squeeze that the NHS currently faces, we need assurances from the Minister that patients and staff will come before finance and that today will be the last time we hear such a damning message about what is going on in our NHS.

       
       
    • I thank the shadow Minister for his questions and the manner in which he put them before the House. His first key question was to what extent measures are in place to address this sort of issue, should it arise again. Post Francis, and following Sir Bruce Keogh’s review of 14 trusts with high mortality rates, a new regime has been put in place. There is a new chief inspector of hospitals, Professor Ted Baker, and a specific regime involving NHS Improvement, which commissioned this report. NHS Improvement has a new chair, Dido Harding, a very senior figure from the business community.

      That regime has put 37 hospitals into special measures so far. The methodology that is used to alert regulators to areas of concern has also been revised. For example, far more importance is now placed on staff and patient surveys. However, it remains to be explained why a trust could pay so many compromise agreements, for example, in response to so many staff disciplinary issues. I assume that many concerns were raised by trade unions locally, as no doubt the hon. Gentleman is aware. We must also consider the extent to which earlier reports, such as the Capsticks report, raised concerns that should have been addressed. That is why, in my statement, I signalled my desire to look at those issues and ensure that they are addressed by the fit and proper person test in particular. As he will be aware, though, that test pertains only to board-level appointments in the NHS, not to all roles. We will need to look at that scope, at the effectiveness of the investigation and particularly at the revolving door element of the problem, which he recognised.

      Turning to the other issues that the shadow Minister raised, we clearly need to ensure that due process is followed. I do not need to remind the House of the difficulties of any enforcement against for instance, Fred Goodwin in financial services or Sharon Shoesmith in child services. People rightly expect due process, and all hon. Members would ask for that. The victims will rightly ask, “How can the chief executive, with this catalogue of issues, move within the NHS rather than be fired?” I know that the hon. Member for West Lancashire (Rosie Cooper) has many concerns about that, as do the Health Committee and many other Members.

      I look forward to working with the hon. Member for Ellesmere Port and Neston (Justin Madders) in the spirit in which he raised these issues. We share concerns, and I know the House as a whole wants us to get to the heart of them.

       
       
    • I pay tribute to my colleague on the Health Committee, the hon. Member for West Lancashire (Rosie Cooper). She is a remarkable parliamentarian and advocate for patient safety. All of us on the Committee look forward to working alongside her to examine in full the Kirkup report’s recommendations, and I welcome the Minister’s commitment to a review of the fit and proper person test.

      On the wider issues that the report raises, it is clear that when staff and funding continue to be cut from community services, there are terrible consequences for patient care. Will the Minister assure the House that he will work closely alongside the Care Quality Commission to identify other trusts in which issues such as this are likely to arise because of the workforce and funding pressures that are now being faced?

       
       
    • I am very happy to work with my hon. Friend on this. As she will be aware from reading the report, it is explicit that the finances were there for the existing service. That is stated at the outset of the report. What drove the problems was a wholly unrealistic attempt to seek foundation trust status, with a cost improvement plan that was simply undeliverable. There was a massive reduction, without any attempt to reconcile that with serious issues on staff levels and vacancies. As the report explicitly sets out, when staff raised those concerns, they were bullied, harassed and on occasion suspended without due cause. The culture has changed significantly, and measures have been put in place for how the regime involving NHS Improvement would address such issues and look at cost improvement plans.

      On the extent to which the culture was driving the problems, I refer to the remarks I made in my statement. According to the report, the interim chief executive went in and found a significant underspend—£3 million—in the district nursing budget, at the same time as there were significant vacancies and patient harm. That culture was driving the issue, and that culture is what we need to put an end to.

       
       

 
    • I thank the Minister for early sight of his statement. I certainly echo his comments about our sympathy for the families and staff members who have been involved over the years. I pay tribute to the hon. Member for West Lancashire (Rosie Cooper), although the tenacity required from her perhaps sums up what is wrong with the present system.

      On Dr Kirkup’s observations and recommendations, as the Minister has acknowledged, some individuals did not co-operate with the investigation. Is there therefore a case for a law change to prevent that from recurring in the future, or at the very least for employment and registration sanctions ultimately to be applied to such personnel?

      On the fit and proper person test that the Government have pledged to undertake, will any agreed new standards be applied retrospectively to board members who are currently in place? Again, the Government have acknowledged the revolving door culture, so it is important that the test is done properly. Will they review executive pay for chief executives and senior staff? After Mid Staffordshire and this, what will be done to properly protect whistleblowers in future to allow them to come forward?

      Funding and resources are clearly really important. Dr Kirkup’s report lays bare the fact that the defining strategic objectives were foundation status and a £30 million saving, or a 22% reduction in resources, rather than the true goal of clinical quality. What will be done to ensure that regulators pick up on such contrasts in future, and what responsibility do the Government take for funding and the drive for efficiency savings?

      Lastly, does the Minister agree that this situation confirms the failings of the trust system, and that any privatisation of the NHS and profit before care cannot be allowed under future free trade deals?

       
       
    • The hon. Gentleman raises a number of important points, but particularly regarding whistleblowers. That was one warning signal that clearly failed here. The regulations have been changed, as he will be aware. In the past, there was a culture in which compromise agreements were applied with gagging clauses attached. That prevented visibility of the compromise agreements. That is why I asked, on receipt of the report, why the compromise agreements that were paid were not escalated to the board, and indeed what sight, if any, regulators had of those compromise agreements. Clearly financial payments will have been made, so there should be an audit trail.

      The hon. Gentleman asked what changes had been made. An area on which my right hon. Friend the Secretary of State has placed a huge amount of importance, and in which he has given a huge amount of leadership, is patient safety guardians and ensuring that there are people in trusts tasked specifically with giving voice to patients. One of the many sensible pieces of advice that my predecessor, my hon. Friend the Member for Ludlow (Mr Dunne), gave me was that when visiting a trust, I should have a one-on-one meeting with that individual, not only because of their status within the trust but to gather information from them. He did so assiduously on all his visits.

      The wider point is how, from a regulatory structure point of view, we can ensure that there are safeguards when there are cost improvement programmes and ask what visibility there is of them. NHS Improvement has set out a series of measures to ensure that trusts learn the lessons of Francis. Obviously the period covered by the report goes back as far as 2010, but it is important that the NHS learns from the issues that Dr Kirkup sets out.

       
       
    • May I add my tribute to the hon. Member for West Lancashire (Rosie Cooper)? She is a formidable parliamentarian and has done some very good work on this. The report is shocking. Back in March 2015, following other incidents, the Public Administration Committee produced a report investigating clinical incidents in the NHS, in which it recommended the setting up of the health service’s safety investigation branch. The Government have now published the draft Bill for that. When will it enter pre-legislative scrutiny, so that we can change the culture and have the open learning culture that we should have in our NHS, very much as is seen in the airline industry?

       
       
    • My right hon. Friend raises an important point on the draft Bill and the consultation. I am not in a position to announce a date; that will be announced by business managers in the usual way.

      My right hon. Friend is right to allude to that Bill as one of a suite of measures following Sir Bruce Keogh’s review and the Francis report, which are all part of changing the culture. I acknowledge the importance of those measures, but I want to signal to the House today that Dr Kirkup’s report identifies remaining issues that need to be tackled. He has done us that service, and that is where I am keen that we focus as a Government.

       
       
    • Thank you for your indulgence, Mr Speaker. I do not intend to test your patience today by dealing with the details of these matters; I will do that through Adjournment debates, questions, the Health Committee and other mechanisms available to me.

      I thank the Minister for his kind words and his comprehensive statement in response to the excellent work of Bill Kirkup and his team. I pay tribute to Dr Kirkup for his thoroughness and independence, and I thank him most sincerely, on behalf of the staff and patients in Liverpool who suffered really badly at the hands of what I want to call a dictatorship—the regime. Whatever it was, what was done was done in our name and the name of the NHS, and those people deserve justice.

      After the ACAS review, the CAP6 report and now the Kirkup report, with a National Audit Office report on the way and Nursing and Midwifery Council hearings due soon, it really is important that the NHS ensures that justice is not only done but seen to be done. Under Governments of all parties, the higher echelons of the NHS have closed ranks to protect themselves. That has got to stop. That senior people were able to inflict such harm on staff and patients and then just walk into other senior NHS jobs with six-figure salaries, and that in this case it could be arranged by the north regional managing director of NHSI, Lyn Simpson, is simply staggering.

      I still cannot answer the question that the Minister posed—why were the chief executive and the board not fired? Why were they not sacked? It is incomprehensible. Nothing has been learnt over the past four years. As of only a few weeks ago, NHSI is presiding over another potential LCH, over in the Wirral’s hospitals trust.

      I will obviously continue to pursue these matters with vigour on behalf of the staff and the patients, and I want to place it on the record for everyone who is affected that I do not see the Kirkup report as the end—far from it. The Minister has a legal and forensic background. How will he assure the House that these matters will be dealt with properly, and that cover-ups and backdoor deals have ended once and for all? The Secretary of State has said so many times, “This will stop. We are not going to keep moving failed executives around,” yet it continues to happen.

      I will say quite honestly that I asked a question of a Minister last year and he answered me in good faith. He said, “NHSI doesn’t participate in moving staff around.” Not only can we now prove that it is true that it does, but it nearly happened in the Wirral a few weeks ago. The message has got to go out: “If you do this kind of stuff, you are responsible. You will not escape.” The NHS must be accountable, and those in it held responsible.

       
       
    • I thank the hon. Lady for those comments. As I said, I have asked NHS Improvement and NHS England to clarify the circumstances under which roles were found or facilitated for individuals identified in the report as bearing some responsibility for the issues at the trust. I await the answer to that central question, which the hon. Lady posed.

      On the sense of cover-up, the Secretary of State has provided leadership in bringing about the culture change on patient safety. Following the awful situation in Mid-Staffordshire, it was recognised across the House that changes needed to be made on patient safety, and I think the NHS itself has recognised that. NHS Improvement has new leadership, who commissioned the Kirkup report themselves.

      On the changes that have been put in place, I alluded to the CQC regime and the chief inspector and the methodology. I spoke to the chief inspector yesterday. Every hospital has now been visited, using that new methodology, and obviously that programme will start to accelerate and target as further work visits are done. The methodology used for that has also evolved to include staff surveys, for example. So a number of measures have been taken, and the special measures regime is also very much at the heart of that.

      A number of steps are being taken, but the approach that underpins those is that although we must create a duty of candour, enabling people to learn from the mistakes that will happen in an organisation employing more than 5 million people, there should not be the sense that people can escape their responsibility by moving within the system. I have discussed that with people in the NHS, and I believe there is a wide recognition that the culture has changed significantly. But clearly, as we consider the issues that emerge from the Kirkup report, the House will need to see further reassurance.

      The hon. Lady asked how I and the Government will ensure that these issues are addressed, not covered up. First, no one doubts that the hon. Lady will use all the parliamentary tools to pursue this matter, including in her role as a senior member of the Health Committee. I am aware that other members of the Committee, such as the hon. Member for Liverpool, Wavertree (Luciana Berger), a former shadow Health Minister, will take a significant interest in this issue. I know that the Chair of the Health Committee will do so. I have regular discussions with her, and as we address the “fit and proper” test and other issues, I look forward to benefiting from the expertise on that Committee.

      It is clear that measures have been taken, and it is right that we recognise that much work has been done in the NHS to change the culture, to ensure that the warning signs are seen, and to ensure that something like this never happens again, but it is also clear that there are specific issues in the report to be responded to, and I very much share the desire of the hon. Member for West Lancashire that we do that.

       
       
    •  
    • Order. I remind the House that there is another ministerial statement to follow, and that although the debate on matters to be raised before the forthcoming Adjournment is not now intended to take place, no fewer than 19 Members wish to take part in the debate on community banking, so there is a premium on brevity. These important matters having been preliminarily aired, I now appeal to colleagues to ask single-sentence, pithy questions, without a great preamble, then we will progress towards other matters. I now call Sir Oliver Heald.

       
       
    • My hon. Friend will be aware, and indeed has said, how bad the situation was at Liverpool prison, where the trust had no understanding of what was required of it in its role as health provider. That put healthcare staff in a very difficult position. Does he feel that there is a need for better liaison between health and justice in relation to prison health facilities? Is the CQC really in a position to inspect them, or should there be joint inspections by Her Majesty’s inspectorate of prisons and the chief inspector of hospitals?

       
       
    • I spoke to colleagues in the MOJ yesterday about the issue that my right hon. and learned Friend raised in the first part of his question. I agree with him that the standards of care for those in prison should be the same as those in the NHS more widely. As he will know, NHS England took over commissioning for healthcare services in prisons in 2013; that is one of the changes that have been made. He will also know that the Dr Kirkup’s report drew attention to local factors, including a personal conflict of interests that goes to the heart of the relationship between the trust and the prison. However, he is absolutely right to allude to some wider issues from which we need to learn.

       
       
    • How many members of the board failed to co-operate with this scathing review, and can the Minister name them?

       
       
    • Only one member of the board co-operated with the review, from which we can deduce that all the rest did not. Given that I am relatively new to the Department, it would probably be wise for me to seek clarification on the extent to which individuals should be named, but I am happy to confirm that the chair of the board did not co-operate.

       
       
    • Does the Minister agree that the report shows that leadership really matters in our local NHS? What further steps can he take to ensure that hospital trusts fully understand the importance of transparency to clinical quality and patient safety?

       
       
    • My hon. Friend is absolutely right. That is why we are increasing the number of doctors in training by 25%. We are also looking into how we can increase the number of clinicians in leadership positions in trusts, and how we can reduce variance. That is one of the key issues. The NHS has some brilliant leaders, but the variance between trusts is far too wide.

       
       
    • Given that health is devolved to the Scottish Government, Mr Speaker, you may wonder why I am asking this question. Will the Minister reassure me first that the report will be shared with NHS Scotland and the Scottish Government, and secondly that, as and when senior appointments are made, there will be an ongoing, constructive and informed dialogue across the border? Now you will see why I asked the question, Mr Speaker.

       
       
    • I am happy to reassure the hon. Gentleman, but he has raised an important point. The question of people moving within the United Kingdom is not the only issue; another potential issue is the question of people moving to a charity or a private company that is providing services for the NHS, or taking up other roles in the healthcare landscape.

       
       
    • May I press the Minister a little further on his worrying suggestion that revolving doors are often facilitated by those who are tasked with regulating them? Will he also look at democratic accountability not just in the appointments of officials, but more widely in the NHS?

       
       
    • I referred earlier to my desire to work on these issues with members of the Health Committee, who include my hon. Friend, and I shall be happy to look into the points that he has raised. The previous statement was about the culture in the House of Commons. I think that what goes to the heart of my hon. Friend’s question and the matters that we are discussing is that issue of culture, and the need for the culture in pockets of the NHS to change. My right hon. Friend the Secretary of State has done a great deal to bring about such change, particularly in respect of patient safety, but I shall be happy to work with my hon. Friend to take that further.

       
       
    • What lessons can be learnt by Liverpool Community Trust—and, indeed, by other underperforming trusts—from the successful turnaround of some 20 trusts under the Government’s new special measures scheme?

       
       
    • My hon. Friend is right: although 37 trusts have gone into special measures, a significant number have not just moved out of special measures, but moved from “room for improvement” to “good”. That is relevant to a much wider challenge in the NHS, whether it involves procurement, workforce planning, or mentoring for junior doctors. I met the family of a junior doctor last week to discuss mentoring and support, particularly for those in their first year out of medical college. Trusts have shown leadership on a number of issues, and I think that the special measures regime has shown the scope to spread that best practice much more widely across the system.

       
       
    • I agree with the Minister that it is vital for us to expose and tackle failings in the NHS, especially when they put people at risk of harm. Does he agree with me that this case highlights the fact that money is not always the only answer? Effective leadership and responsible management are also important.

       
       
    • My hon. Friend is right. I think that at the heart of Dr Kirkup’s findings was the conclusion that what drove these events was not money—and he made that point specifically in relation to the finance for the initial services—but the desire to seek foundation trust status, which led to a wholly unrealistic cost improvement plan and an unwillingness to address the issues that arose as a consequence.

       
       
    • I thank my constituency neighbour, the hon. Member for West Lancashire (Rosie Cooper), for all the work that she has done on this issue.

      As has already been said, it is important for the right culture to exist in our NHS. However, it is also important for those who compromise patient safety to be brought to book and punished, and for us to know what action was taken, because otherwise the same thing will keep happening.

       
       

  • My hon. Friend is right. Professor Ted Baker, the chief inspector of hospitals, has drawn attention one of Dr Kirkup’s findings, which is that the CQC is now in a much better position to challenge and fine those responsible for unsafe care and poor standards. That also reflects the excellent work that Professor Baker and his team have been doing to ensure that inspections become much more rigorous in identifying issues such as those that we have been discussing today.

     
     
  • I am a member of the Justice Committee, which has taken a particular interest in Liverpool prison. Will my hon. Friend assure me that there will be a review of the suicidal potential of prisoners to ensure that the systems are right?

     
     
  • My hon. Friend is right to allude to the importance of learning lessons, especially given that there are many vulnerable people in prisons, and given the risks that accrue as a result. Yesterday I spoke to the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), who is responsible for offender management issues, and the Prisons Minister, my hon. Friend the Member for Penrith and The Border (Rory Stewart), visited Liverpool prison last week. I know that they have both taken a great interest in the report, and that they will take any further action that is needed.

     
     
  • Does my hon. Friend envisage an ongoing oversight role for Dr Kirkup that would enable him to help to put these failures right?

     
     
  • I should be happy to discuss any such future opportunities with Dr Kirkup. His excellent report builds on the work that he did at Morecambe, and I think there is a huge amount for us to take forward from its findings.

     

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