6 February 2011

Stafford Hospital Inquiry. - The Bill Cash Story.

I have indicated previously that I believe the press has played a major and malign role in the story of the Stafford Hospital. Last week I was there as the cracks in the case for the Inquiry finally became visible for all to see.

When it happened there were only two journalists there, I was aware of the enormous complexity of the story unfolding in front of us, and the real difficulties that this would give journalists in the tiny space that is available to them. I was not confident that the full story would be told, so let me tell you the story as I saw it.

Picture the Scene. The Stafford Borough Councils’ committee room is crammed with lawyers, their staff and some of the “core participants”. In the adjoining room there is the public – made up of the hard core of the protest group, the press and a scattering of people with some other interest. We were watching banks of video screens with live coverage of the inquiry, the written words that miraculously keep track with the hours of speech, and the occasional “exhibits”. We were able to peer through directly into the room where it was all happening. The space allocated to the audience is greater than it need be as the legal staff probably outnumbered the “public”.

I came because I wanted to judge for myself how thorough and well focused the Inquiry process is, and to see in particular how it went about holding to account the various MPs involved in the story.

What I saw was something intimate, forensic, careful, on occasions kind, on occasions merciless.

The first day that I saw was spent with David Kidney. The second was with Jeremy Lefroy, and Bill Cash. I have also read the transcripts from Tony Wright.
These days followed the appearance of two members of the local authority health scrutiny committee, who found themselves in the unfortunate position of having to admit that they had not actually read any of the major reports on the Hospital, and found themselves ridiculed by the press.

The press had its pre-conceptions on all of this. The Express and Star has throughout the two years of this story taken the view that David Kidney, who did not fully accord with their “local hero” was the villain of the piece, and that Bill Cash who had clamoured for the heads of a succession of people, and given the “local hero” his full support became an unlikely knight in shining armour. The press expected their view of the story to be borne out by the Inquiry room appearances. It is to the credit of the skilful people conducting these hearings that this is not what happened.

What all of the elected representatives at different levels would I think completely agree is that they are not experts on health, or statistics, or the structure of the NHS, or hospital finance, and that it can be difficult to understand clearly what is happening, especially when they are being confronted with reports assessments and ratings which are giving conflicting information. All recognise that this is an area where they have to be guided to some extent by the experts.

What all these people, and all the many other available sources of information that we have seen, will also agree is that the number of complaints that they received before the beginning of the Cure the NHS press campaign were minimal. They saw nothing out of the ordinary happening at Stafford.

Where the difference between the MPs was startling was in their activity levels. With David Kidney I already knew the colossal amount of work that he did to try and understand what the issues were, and to move things forward. I was glad to see at least a small fraction of this work was finally made visible by the Inquiry, though telling the full story of what he attempted will require a full book, which I may write at some point.

Jeremy Lefroy is clearly also committed to working hard for Stafford. What struck me from Jeremy’s testimony is the degree to which he whilst merely a candidate for Stafford he had to rely on the press for his information. This is highly dangerous. Over the last couple of years I have come to know many of the young journalists involved in covering this story. For the most part I like them. They are all decent people trying to produce good copy. They are also working under impossible pressures. It is putting an intolerable burden on them if we expect them be our main source of information about the “truth” about such complex matters, and it would be wrong to blame them too much if they sometimes get things wrong.

I am already approaching the new MP Jeremy Lefroy to request that opposition parties are given regular confidential briefings on issues of concern to ensure that battles based on garbled information are not in the future fought out through the press. In my opinion what has happened has been immensely damaging to Stafford and should never be permitted to happen again. Here or elsewhere.

What came as a shock to me, and I think to the public and the two journalists in the room with me, was the evidence from Bill Cash. For those who are not familiar with this story it was Bill Cash the MP for Stone, who acted as a mentor for the Pressure group, and was there at every available television interview, or Westminster debate to forcefully lead the demands for this Inquiry. I am giving here only a fraction of the content. You can get the full text here.

The questions began. As with all the MPs the inquiry wanted to know how much he might have known about any problems at the hospital before it became a matter of interest to the press. This was the usual story. He had just seen a trickle of individual complaints, no pattern, nothing at all remarkable.

The inquiry then looked at how he dealt with the complaints. Constituents with a problem, would either send him a letter, or visit his surgery. If they came to the surgery he would ask them to follow up this with a written account of their problem. He, or his assistant, would then take their letter, attach a standard letter to it and forward it, in the case of Health related problems to the Department of Health. At that point it would become a matter for the Department of Health to pursue with the hospital. This is in direct contrast to all the other MPs who take much more direct action, writing reports, contact the hospital, and following up the complaint.

The Inquiry wanted to know if he had found this an effective method of dealing with complaints, and if he ever felt the need for any direct contact with the hospital. Mr Cash thought that if constituents were not satisfied that they would come back to him.

The Inquiry wanted to understand Bill Cash’s level of interest in the hospital.

Q One of the criticisms that is sometimes made of MPs is that they don't get interested in something until there are headlines involved

The inquiry noted that Mr Cash had not met either Martin Yeates or his predecessor. They asked if he had visited the hospital between 2003-2008. He thought that he had not done so. They again asked if he had visited after 2008. He thought not.

The inquiry tested his knowledge of the ways in which the health service has been administered. Mr Cash has made a number of strong public comments critical of the organisational structure and of named individuals within in. It transpired that these criticisms were typically based on the opinion he formed of seeing a single report, or attending a single meeting. At the prompting of the inquiry he qualified some of his earlier statements.

It emerged that he had been invited to many seminars and briefing meetings that would have helped him to form a more rounded impression of the administrative process, and he did not attend.

He was asked about his understanding of the Mortality statistics that have formed such an important part of the entire case of the hospital.

A“I honestly can't pretend to have any scientific understanding of it at all.”

On the crucial matter of the co-morbidity coding:

Q Would you have any understanding as to whether the way in which patients were coded when first diagnosed would have upon the statistics?
A. Not at all.

There was one quietly damning piece of paper. Because he had been alerted to the possibility there was a problem by articles he read in the press, he had requested a briefing from the SHA at the time when the Healthcare commission investigation into mortality rates at the hospital were beginning in March 2008. He had personally annotated a paragraph which indicates clearly that there are problems with the systems for measuring mortality statistics, and these were being actively investigated by Birmingham University, as a key part of the HCC investigation.

With regard to the Healthcare commission investigation, whilst the other MPs involved were providing all their background material on the hospital and writing full statements, Bill Cash did something different. Cure the NHS had made contact with him in December2008 and began making regular visits to see him. He asked them to produce a report which gave their version of events, and he then forwarded this report drawn up in January 2009 to the Healthcare Commission.

The Inquiry asked Bill Cash if the comments made in the Cure report represented his own views, but he did not think it was his role to form views. So Bill Cash’s “evidence” to the HCC will have been identical to that given by the pressure group, which was also identical to the material they will have made available to the press.

This very high level of agreement between the "different voices" in the story is something that I spotted in my recent excercise of reviewing all the local press coverage for the last two years, and it troubled me. It was often difficult to distinguish between the messages coming out from the pressure group, the reporters, the editors and various speakers in the Conservative party. Bill Cash's evidence clarifies how this happened. They were all coming from the same source.

The Inquiry moved on to the publication of the HCC report. It raised with Mr Cash that he had received a draft copy of the Healthcare commission report the day before publication, and that he was quoted by the press, in the article that uses for the first time the misleading “excess death figure” of 400, that was published on the day before the official report. This highly emotive figure then completely overshadowed the release of the healthcare commission report, which neither says nor implies these figures.

In the words of the Inquiry

Q. You did, however, I think, quote the figures on a number of occasions in the press. I think you quoted the 400 figure; do you remember that?
A. I don't actually, no.
Q. I mean, I expect you would agree that one has to regard these sort of figures both in a careful way and a responsible way, because they can raise high emotions?

Following these first visits to the inquiry I am left with more questions. It is not at all unreasonable for elected members to find the information they have been confronted with confusing. Anyone would! But how far should we expect them to go to find out the truth. David Kidney and Tony Wright both asked the complex questions and were given the complex answers which form the truth in this case. They then both actively involved themselves in working to find effective solutions to the real problems that existed. Jeremy Lefroy to all appearances is trying to follow their example. Bill Cash decided that the detail was beyond him, he decided to pass on the responsibility of understanding all this complex detail to a Public Inquiry. I am left asking the question, Has Stafford gone through two years of torment, at a huge expense to the tax payer, because Bill Cash took his information from the press instead of picking up a phone to ask people who understood the detail?

We have been in an echo chamber of misinformation. It began with a set of confusing statistics, and with key people who did not understand why the figures were problematic. The myth of the “excess deaths” simply grew, sucking in the press, cure the NHS, Bill Cash, the Conservative party, and then thousands of people in Stafford and throughout the county.

It is time to switch off the echo. Stafford is being used right now as the justification for destroying the structures of the NHS. There are real threats of Hospital closures. We do not want Stafford to be one of them.
Many of the proposals of the health bill are being shown as incoherent by the evidence to the Inquiry. We need to stop these proposals whilst we still can. Structures always need reform, and local accountability is to be actively encouraged. The evidence to the Inquiry has shown us a Health scrutiny that did not scrutinise, GPs who did not communicate any concerns, Patients forums that did not understand and could not perform their role. Bill Cash has his doubts about the ability of local elected representatives to be responsible for their hospital. I agree with him. This is “big society” fantasy land.

We have had this hugely expensive inquiry to see why none of the bodies with a responsibility for the hospital agreed with Cure the NHS. Why could they not see that hundreds of people were dying unnecessarily, as the pressure group thought the Dr Foster statistics were telling them. It may be months yet before Robert Francis gives us his considered opinion, but I believe a careful reading of the evidence given by Bill Cash, in conjunction with all the previous evidence given to the inquiry, now gives us the answer. We are looking at a statistical anomaly. The pressure group were completely right in identifying some problems in basic care which still remain a real challenge both in Stafford and throughout the country. There were also a small number of tragic medical accidents, which occur sporadically throughout the country, and which have left real people with a huge burden of grief. After studying this matter now for three years I have seen no evidence at all to support the idea of large numbers of “unnecessary deaths”.

The reasoning behind the Inquiry may have been muddled, but Robert Francis will bring something good from this, as he did with the Independent Inquiry. The focus must now shift from looking for blame for the mythical 400 to working out how we can protect our health service from the chaos the health bill threatens.