Health and Care Bill

Debate between Baroness Brinton and Baroness Young of Old Scone

Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I will speak to first three amendments in this group, but I support the others.

The office of the Health Services Safety Investigations Body is vital. It has the capacity to make the step change in patient safety that Parliament has been asking for on a regular basis, over many years. Amendment 308 makes it clear that it is vital that there needs to be scrutiny of the appointment of the chair and the chief investigator by Parliament. The history, outlined by the noble Lord, Lord Hunt, but also in the amendments your Lordships’ House has considered during the course of the Bill, arises very much out of the recent First Do No Harm report, which the noble Baroness, Lady Cumberlege, led. This was a recommendation, as the noble Lord, Lord Hunt, said, of the Joint Select Committee, pre 2019. It emphasises the public scrutiny of these appointments, the importance of the HSSIB and the fact that it must fulfil its duty to the best of its ability and be very much in the public eye.

Amendment 308A talks about financial stability over a period of years. It is all too easy for new bodies being set up by the Government to have a one-year budget. I am thinking, just as an example of the moment, about the position the public health budget has been in, where there is no stability at all. Quite often, in March, health bodies find out exactly what they will get to start the next financial year in April. Let us not do that with the HSSIB. Let us give it a three-year plan for financial stability.

Amendment 309 is vital if the HSSIB is going to succeed. It has to have adequate funds and resources to carry out one of its core roles—that of investigation.

I also echo the concerns of the noble Lord, Lord Hunt, about coroners, and support the amendments in the name of the noble Baroness, Lady Young.

[Baroness Young of Old Scone (Lab)]

My Lords, I will speak to our Amendments 310A, 311A, 312A and 319, and I thank the noble Lord, Lord Patel, and my noble friend Lord Hunt of Kings Heath for their support. I declare former interests as a chair of the Care Quality Commission and a recent chancellor of Cranfield University, which has a major teaching research role in air, rail and accident investigation in the UK and globally.

I share the view of my noble friend Lord Hunt that this is an important step forward for patient safety. The whole point of setting up the HSSIB is its independence and the concept of safe space and protected material. However, the Government, having made a good call in proposing that it be set up in these terms, have immediately screwed up—if noble Lords will pardon the technical term—by eroding its foundations from birth.

I know we are not supposed to rely on Explanatory Notes, but I will quote them, as they give some indication of the original and admirable intentions of Government:

“The Bill creates a ‘safe space’ within which participants can provide information to the HSSIB for the purposes of an investigation without fear that it will be disclosed to others.”


This good model can be compared with the air, rail and marine accident bodies. Safe space enables the improvement of safety by promoting learning and not attribution of blame. This is a founding principle behind establishing a safe space.

The importance of safe space is well documented in air accident investigation. The key point is that the evidence is collected on a not-for-blame basis and cannot be utilised in another, different sort of investigation. There are UK and international examples of the chilling effect of the impact of compromising the safe space principle. I can provide them for the Minister, if she would like them.

One of the most graphic examples I heard was a fatal air accident in New Zealand where police seized the cockpit voice recorders. The result was that pilots across New Zealand no longer trusted the CVR data to be protected as a matter of principle and withdrew their co-operation from the collection of cockpit voice recorder data. In fact, they routinely disabled the CVRs after the start of each flight and reported it as a fault. This withdrawal of co-operation continued until full protection of the CVR data was put in place in line with international standards. That is a sign of what can happen to a community of interest if they do not feel they can trust the rules.

Children and Families Bill

Debate between Baroness Brinton and Baroness Young of Old Scone

Wednesday 29th January 2014 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I, too, offer my thanks and congratulations to the Minister and the Government for the considerable progress made since Committee and for the frankly stunning indicative guidance. It is not yet out for consultation, but it is extremely helpful. Of course, the problem with providing your Lordships’ House with such prospective guidance is that we all have things that we think could better it. I will not repeat the points that noble Lords have already made, but will add briefly the two or three that I am concerned about.

I reiterate that the guidance must make it explicit that children with diagnosed health conditions are given an individual healthcare plan, even if there are no obvious actions, not least because medical and health conditions change and for a child at school suddenly to have to go through that process, when it was known about at the start, seems rather foolish. It will speed up the planning process and the school’s ability to monitor the child’s health if they are already on the radar of the school.

I particularly like the section in paragraph 39 on unacceptable practice. This is extremely helpful, but there is one glaring omission. Nowhere does it say that schools must take account of a doctor’s diagnosis rather than make their own. In Committee I mentioned a young man who was struggling with severe ME and chronic fatigue syndrome; but because the head did not believe that ME existed, he was given no rest times and was actually excluded because he was unable to take part in sport, which was deemed to be bad behaviour. Despite the fact that his hospital consultant had given the school formal advice, the head chose to ignore it. That is unacceptable bad practice and, in my view, it needs to be included.

That relates also to the ambiguity in the guidance about whether pupils with medical conditions should have individual healthcare plans. We must not have a get-out clause for schools. I hope that the Minister will be able to give reassurance on that point and others that my colleagues have made.

Finally, I give my particular thanks to the Minister and his team for meeting me to discuss my idea about access for teachers with frequently asked questions on a range of health conditions. This is now progressing: discussions are about to start with officials in the Department of Health. I know that the Health Conditions in Schools Alliance already has a date to discuss that and other things with the department in the very near future. When a school nurse is not around, this tool for teachers is going to be absolutely vital. It is not going to be technical and complex but will help to alleviate the fears that a teacher will have if a child suddenly moves into their class with a condition of which they have no experience at all, and if they want to understand both the learning and social implications of such a condition.

[Baroness Young of Old Scone (Non-Afl)]

My Lords, at this time of night I shall be brief and not repeat anything that has already been said. However, I wish to make effusive remarks about the Minister’s response to the case made by the Health Conditions in Schools Alliance and for bringing forward a government amendment to the Bill, for which we are grateful. I thank the Minister for ensuring that the indicative draft of the guidance was available before we discussed this element of the Bill.

I thank the noble Lord, Lord Kennedy, for proposing this very important amendment. He sought a response from the Minister on what happens if a school—schools now have a very clear responsibility to look after these children—fails to get an adequate input from the local health system in terms of support and making plans for individual children. From time to time staff at schools across the country say that they would like to provide a better response in this regard but are unable to do so because they do not get adequate training and support from the local health system. Therefore, this amendment is important as it would reinforce the existing duties under the Children Act—which, alas, are currently ignored—and make sure that a school is not put in the impossible position of having a statutory duty but no means of carrying it out if it is not given the necessary support.

School nurses are important but so are specialist nurses for various conditions because in many cases their specialist knowledge will be required to establish an adequate plan for each child. Therefore, this issue cannot be left simply to school nurses, quite apart from the workload issue that the noble Lord, Lord Kennedy, raised.

I know that this issue is of great concern to the trade unions. It was, indeed, their only stumbling block. I held the mistaken belief that the trade unions were not willing to take up this challenge on an ideological basis. However, their concerns were practical ones. They were very willing to see teachers give this support to children provided they were properly supported and trained to do so. Therefore, the question is: what does a school do if the NHS does not step up to the plate in providing training and support for it?

The indicative guidance rightly talks about the role of Ofsted in ensuring that schools meet this new duty. However, there needs to be further discussion between the department and Ofsted about the latter’s role and what it will be able to do in relation to this issue. The guidance says that inspectors are already briefed to consider the needs of pupils with chronic or long-term medical conditions and to report on how well their needs are being met. However, that was not quite the impression I got when I met the Chief Inspector of Schools a few weeks ago, so clarity is needed about what requirements will be laid on Ofsted, not perhaps in terms of this duty being fully inspected but at least the forthcoming guidance to inspectors should brief them on it. Perhaps at some stage an ad hoc report could be produced on how well the guidance is being implemented. I press the Minister to tell us what a school will do if it hits a brick wall with the NHS.