Patient Safety Commissioner

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Thursday 2nd December 2021 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

Those are both very important questions. We place enormous emphasis on patient safety, which is central to effective functioning of the NHS. Appointing this commissioner will make sure that we are beginning to go ahead with that. As far as accountability is concerned—the consultation has not been announced yet, so I am probably going to be told that I am going beyond my brief—there is supposedly going to be an annual report. The commissioner will produce an annual report, to be laid in Parliament, setting out activities undertaken during the year. The commissioner may appoint an advisory board whose members will have a broad range of relevant interests, experience and knowledge of the health system.

[Baroness Jolly (LD)]

My Lords, how will the Secretary of State inform the public about the commissioner and his or her role, and how should he or she be contacted?

[Baroness Chisholm of Owlpen (Con)]

I think that that will all become obvious when we have set out exactly how this is going to work. The fact that the commissioner has to report to Parliament annually is one way. How patients themselves will get in touch with the commissioner will be laid out in the regulations when that has all been sorted out.

Healthcare (International Arrangements) Bill

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I too support the amendments in the names of the noble Baroness, Lady Thornton, and my noble friend Lord Marks. I repeat the view that he and the noble and learned Lord, Lord Judge, expressed: we should be producing only legislation resulting from the decision to leave the EU. I thank the Minister very much for meeting us and for the government amendments—particularly to those Henry VIII clauses, which have absolutely no part in modern legislation.

I agree with previous noble Lords, but any Bill dealing with healthcare agreements outside the EU is different. I would be happy to look at these issues in another Bill at another time. As has just been said, the expansion in scope of the Bill looks opportunistic and is completely inappropriate at the moment.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I cannot agree with these amendments. As we pointed out during the progression of the Bill, we live in a global world, with more people travelling internationally for all kinds of reasons. There is obviously a huge demand for healthcare systems between countries, giving the traveller peace of mind that the foreign country they are in can respond to healthcare needs.

As was also mentioned, we already have simple reciprocal agreements with non-EU countries. The domestic implications are limited, and our current powers to charge domestic overseas visitors, and the regulations under such powers, provide for domestic implementation. Importantly—

Health: Folate

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Thursday 1st March 2018 Lords Chamber

[Baroness Chisholm of Owlpen]

Well, I cannot. I am sure that he would be willing to meet, but I cannot answer for him. The noble Baroness is completely right. One reason that there has not been movement on this until now may be because of problems with the upper level, which this report says is not a problem. If the upper level is no longer needed, that will provide reassurance on the safety of mandatory fortification and we will be able to proceed.

[Baroness Jolly (LD)]

My Lords, much of the first world, and indeed parts of the rest of the world, are heeding the advice of British scientists, and I am delighted that we are here now getting a bit nearer to putting folic acid in flour. The Minister said that several departments would need to be involved in this. Will she tell us which departments?

[Baroness Chisholm of Owlpen]

Yes, Defra and the Department of Health.

Human Fertilisation and Embryology (Amendment) Regulations 2018

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Tuesday 27th February 2018 Grand Committee

[Baroness Jolly]

I did not mean to mislead the Minister, I just anticipated that many more regs would need a similar sort of exercise to that we have done today—in the NHS health sphere and in general. The question was really about workload: how many more do we expect to come down the track, when do we expect them to come and are we anticipating that they will be finished by Brexit date? Is there any indication that they are being done on a slightly ad hoc basis or are some being prioritised over others? I am sorry if the Minister is unable to answer that now, but if she wants to write to me, that will be fine.

[Baroness Chisholm of Owlpen]

I cannot give a timing on that now so I will have to write. These regulations needed to be dealt with anyway and they are slightly late, partly due to a general election, so we have to put them in place now. It actually has nothing to do with Brexit. We have to put them in place now, otherwise we would have heavy fines. In a way, that slightly answers the question from my noble friend Lord Deben about why we are doing it. We are making sure that our standards are as high as those of other EU countries, so this is actually transposing existing regulations and making us consistent with the EU; we are not adding anything new.

Pregnancy: Folic Acid

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Tuesday 23rd January 2018 Lords Chamber

[Baroness Chisholm of Owlpen]

No, it is not mulish obduracy. The Secretary of State is minded to look at this again and has asked officials to draw up a plan because we are listening to what everybody says. Your Lordships will just need to wait to see what the Secretary of State comes out with.

[Baroness Jolly (LD)]

My Lords, could the Minister tell the House when the Government last ran a campaign to remind women to take folic acid before they became pregnant and how many women were targeted? Do the Government foresee any future efforts to increase the number targeted, and if not, what responsibility do the Government have towards babies born with neural tube defects?

[Baroness Chisholm of Owlpen]

As I think was mentioned earlier, 50% of all pregnancies are unplanned, so the health education messages are provided in a range of settings, targeting women of child-bearing age. There is the Healthy Start programme, through which free vitamin vouchers are offered to pregnant women on low incomes, who will receive certain benefits. The NHS Choices website provides healthy lifestyle advice during pregnancy, including on the importance of folic acid supplementation, and there is the NHS Start4Life information service. Early in pregnancy, a midwife will provide information about nutrition and diet, including supplements such as folic acid and vitamin D, as well as lifestyle advice.

Pharmacy (Preparation and Dispensing Errors—Registered Pharmacies) Order 2018

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Wednesday 6th December 2017 Grand Committee

[Baroness Jolly]

Indeed, yes.

My noble friend Lord Clement-Jones has given the Committee the detail. I, too, champion local community pharmacies and pharmacists. This SI covers some of the content of his original amendment and will have a considerable impact on the profession. We are all human; we make mistakes. In the previous debate, I outlined a mistake which happened within my own circle at home and caused a large high-street pharmacy to change the way in which it dispensed and stored medicines. The measure will have an impact in that some pharmacists and pharmacy assistants will feel more confident in owning up to making mistakes. We are encouraging people within the health and social care service to do this because we will then learn and share good practice. It is good legislation: mistakes are confessed to and rectified, and lessons are learned.

We heard from the Minister at the outset of this debate that more legislation will be coming down the track to look at other things. When that legislation comes before us for debate, I hope that all the areas that have been exposed today as being in need of tidying will be tidied up.

[Baroness Chisholm of Owlpen]

I hate it when notes come over one’s right shoulder just as one is about to stand up, because one never has time to read them.

I thank all noble Lords for their points. The noble Baronesses, Lady Thornton and Lady Jolly, and the noble Lord, Lord Clement-Jones, all said that the measure was a long time coming. I certainly agree; six years is clearly far too long. I say in mitigation that we were hoping to bring it forward in 2015, but several things happened which I am sure noble Lords will remember: an election, followed in 2016 by a referendum, which rather held things up. Even so, 2009 to 2015 was quite a long time, but we must welcome it now.

The noble Baroness, Lady Thornton, referred to there being no formal requirement to report. We want to encourage pharmacists to feel that they can come forward and report. We do not want to put strong legislation in place for that; we want there to be a feeling of openness, that they can come forward without feeling that that they are likely to be prosecuted. With the champions and the guidance in place, that should happen, and they should get used to this just being part of what they do without fear of further prosecution.

The noble Baroness, Lady Thornton, mentioned pharmacy owners. We want pharmacy owners to have systems in place whereby anyone who discovers an error makes sure that the patient is notified. If this needs doing, the legislation deliberately incentivises candour on the part of all responsible people at the pharmacy. The noble Baroness asked also whether there should be a mandate for reporting errors. As I said earlier, the defences have been drafted to incentivise the reporting of errors not just by the error maker; in addition, all pharmacy professionals are already subject to professional standards set out by the pharmacy regulators, the General Pharmaceutical Council and the Pharmaceutical Society of Northern Ireland. These standards include duty of candour, which includes an obligation to be open and honest.

The noble Lord, Lord Clement-Jones, mentioned pharmacy technicians in Northern Ireland. They are not registered in Northern Ireland as they are here, so they cannot come under these defences. The criminal offences are still there, so this measure makes the right balance. If there is gross negligence or serious errors are made, there is still legislation in place whereby pharmacists can be prosecuted.

I do not have the date for this to go forward for care and hospital settings, but come this summer they will be starting to look into how to bring that forward. It will be interesting to learn how this works in the pharmacy setting and then to bring that forward. We are keen that that happens.

I certainly hear what the noble Lord, Lord Clement-Jones, said about appreciating pharmacies. We do indeed, and we realise what a very important role they have to play not only for supplying medicines but for giving advice. The noble Baroness, Lady Jolly, mentioned one of the errors we hope will be picked up in the new form—coloured boxes. I remember so well as a nurse the danger if you have different medicines in the same coloured boxes when you grab them quickly. Luckily you always had two people checking the medicines in nursing so errors rarely occurred, but that is exactly what we hope this will pick up.

I hope I have answered all the questions raised, in which case I finish by saying that we feel the order will add further impetus to the work already under way to reduce medical errors across the health service and provide much-needed assurance that pharmacy professionals can discuss inadvertent dispensing errors without fear of prosecution. It is important that the pharmacy professions build on this, help to underpin a learning culture that puts the patient first, and ensure that patients receive excellent care and service from registered pharmacies.

Care Quality Commission Review: Deaths in the NHS

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Tuesday 13th December 2016 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I, too, thank the Minister for repeating the Statement and echo the condolences offered by the noble Lord, Lord Hunt of Kings Heath. I declare my interests as set out in the register. I am chair of a learning disabilities charity caring for adults across England.

We welcome the findings of this report but are saddened that we should need one. However, we welcome its publication and recommendations and hope that they will be taken forward and acted upon as a matter of urgency.

I am going to talk about families, governance and learning good practice from unexplained death inquiry processes. In the report, the Secretary of State said:

“The lesson of Mid Staffs, Morecambe Bay and indeed other injustices like Hillsborough is that when families speak out we must listen”.

Surely another lesson is that a trust, or even a regulated care setting run by a charity or the private sector, should reach out to the family first after the family member dies in an unexplained way. We recognise that the emphasis in the report on the importance of including and listening to families in investigations is extremely important, but is this not what common decency should require and families expect, and should this not already be happening?

The situation at Southern Health NHS Foundation Trust reflects what is known across the sector: that whether we like it or not, mental health and learning disabilities are always considered after acute and community services. As long as I can remember—and my involvement with the NHS began at the end of the 1990s—commissioners thought of them last and there was certainly nothing approaching parity of esteem. Now, at least for mental health, we have parity of esteem, and we should have processes in place that are as good and as robust as in all other NHS settings. The chair of the trust should work with the CEO to make sure this happens and a named non-executive director on the board should have ownership of the process. Sadly, this situation is nothing new. Trusts have struggled with this for years and it has to be kept on the agenda. I mean this literally as well as figuratively. It should not be relegated to a subcommittee; it should be on a full board meeting agenda by default.

I commend the processes adopted by Mersey Care NHS Foundation Trust. In such circumstances as we have been discovering, it carries out a review within days, very quickly, while all the involved staff are still in post and details are not forgotten—and, of course, families are involved.

Any good unexplained deaths investigation or complaints system should always have an element of learning built into it. This should be shared within the organisation and also within the sector, and there should be a process to make that happen. Processes currently seem to be ad hoc. Standards and definitions should be standardised into a common framework, as indicated by the report.

I have three key questions for the Minister. First, will the Government consider extending the recommendations of this report to regulated residential settings where those with a learning disability or a mental health condition are being cared for? Secondly, the report outlines the need for a national framework. Will the Minister outline who will co-ordinate the work outlined in the report and who might be involved, and indicate its expected completion date? Finally, will the framework contain recommendations about sharing good practice within the organisation and the sector?

[Baroness Chisholm of Owlpen]

My Lords, I thank noble Lords for the questions that have been raised. I particularly thank the noble Lord, Lord Hunt, for mentioning the sad death of my noble friend Lord Prior’s father. It is sad that I should have to be standing here instead of my noble friend on this occasion.

This is indeed a wake-up call. As the noble Lord, Lord Hunt, said, we have all been absolutely shocked by this report. This is a cross-party issue and something that we all need to get involved in, and I very much welcome the noble Lord’s understanding about that.

The noble Lord mentioned families and carers being equal partners, which is indeed absolutely essential to what is being brought forward. When families have a loved one in hospital, it is absolutely essential that they can be sure that if they have a concern, they will be listened to, whoever they go to. When somebody we love goes into hospital, one of the things we all feel is a sense of relief that they are now somewhere where they are going to be looked after, cared for and treated in the best possible way. If we cannot feel that that care is going to continue when we go home at night, having been with them all day, there is something very wrong with our system. We are going to make sure that that happens, and that is exactly why my right honourable friend the Secretary of State said he is determined that all the recommendations in the report will take place.

Several points were made, and I will try and get through some of them. We feel that this is not an issue of funding. Trusts already have investigations, and we will support them and make sure that best practice is followed, particularly in the training of clinical staff and in improving the way in which they investigate safety incidents. This is not about funding; this is about creating a culture where NHS trusts make sure that if somebody comes forward with a concern, they are listened to immediately. One way to help with that is the board level leader who will be put in place—a patient safety director—to take responsibility for this particular agenda. This has already been tried in the Yorkshire and Humberside region, with good feedback. It is looking at deaths and avoidability, and degrees of avoidability, and where lessons can be learned from the deaths, even if they are inevitable.

I hope that with those remarks, the noble Baroness and the noble Lord will realise that this is a wake-up call for us all and that we are going to take forward all the recommendations. It is impossible to have a timeframe for this, but we need to make sure that it is done properly and that robust actions are taken to make sure that what happened earlier on will never happen again.

Policing and Crime Bill

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Report: 1st sitting: House of Lords
Wednesday 30th November 2016 Lords Chamber

[Baroness Jolly (LD)]

My Lords, the purpose of this amendment is to enable service men and women to make complaints about their service police to the IPCC rather than to the service police—the Royal Military Police, the Royal Air Force Police or the Royal Navy Police. I submitted this amendment after a really interesting and valuable meeting that I had with the Minister and her officials, which helped my thinking and allows me to ask for clarification about the service police and the IPCC. I am grateful to her for her time.

The Minister and I discussed the issues of the competence, culture and trust of or in the service police and the capacity of the IPCC to take over some of its functions. I remind noble Lords that Her Majesty’s Inspectorate of Constabulary—HMIC—recommended that oversight of the Royal Military Police, the Royal Air Force Police and the Royal Navy Police should be brought within the competence of the IPCC. I understand that, at the moment, the IPCC is undergoing some change and is not able or willing to look at meeting the amendment’s desired outcome in the immediate future. I also understand that the service police are aware of their shortcomings and are working to address them.

Can the Minister give some indication of the Government’s current thinking about the future, and about which milestones might indicate progress? If there are any recent pronouncements from the MoD on this issue, that would also be helpful. Our service men and women deserve a process for complaints against their service police that is modern, run professionally, fit for purpose and future-proofed. I hope that the Minister can help, and I beg to move.

[Baroness Chisholm of Owlpen]

My Lords, I would like to reassure the noble Baroness, Lady Jolly, that the Government and the service police are fully supportive of the need for independent oversight of the service police. There is already statutory independent oversight of the complaints made against the service police, where those complaints are made through the service complaints process. That process is overseen by the independent Service Complaints Ombudsman and is available to all serving personnel. Veterans and other civilians are not able to use that process and rely solely on the service police complaints procedures, which do not currently have independent oversight. However, I should mention that, since the recommendation in Her Majesty’s Inspectorate of Constabulary’s 2014 report, the service police forces have adopted a tri-service investigations protocol, which supplements their existing complaints procedure and provides for another force to investigate certain complaints where there could be a conflict of interest or allegations of criminal activity.

There is clearly further work to do on a mechanism for introducing independent oversight into complaints made against the service police. There are a number of options for doing this, including oversight by an existing body or setting up a separate new body to provide it, but a number of logistical and jurisdictional issues need to be addressed. For example, incidents requiring investigation might arise in any part of the UK or indeed anywhere in the world, including dangerous operational theatres, and clearly we would want our oversight arrangements to cater for those occasions.

The Government are therefore considering interim arrangements that will introduce independent oversight of complaints against the service police from veterans and non-service personnel, this being the gap which currently exists. We expect to be able to announce further information about this shortly. The Government remain committed to implementing a single mechanism that will provide for the independent oversight of all complaints against the service police. This aspiration is shared by each of the service police provost marshals, and we intend to update the House on progress in the first half of next year.

On a broader note, I should mention that each of the service police forces has done much in recent years to forge a culture within its organisation that aims to promote faith in its integrity and professionalism within the Armed Forces, military community and beyond. They have each implemented codes of conduct that highlight the expectations placed upon service police personnel both on and off duty. These are akin to those produced by the College of Policing and support the single service’s values and standards and leadership codes, which apply to all service personnel. In addition, all members of the service police are now required to swear an oath which declares that they will always act with fairness, integrity, diligence and impartiality. The Government are determined to ensure that, in both the short term and the long term, there can be independent scrutiny of any instances where those values are called into question. On this basis, I ask the noble Baroness to withdraw her amendment.

[Baroness Jolly]

My Lords, I thank the Minister for the clarification and for the meeting. I look forward to recommendations coming out very soon, as she said. In the meantime, I am happy to beg leave to withdraw the amendment.

Policing and Crime Bill

Debate between Baroness Chisholm of Owlpen and Baroness Jolly

Committee: 2nd sitting (Hansard - part one): House of Lords
Wednesday 26th October 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

As the noble Baroness, Lady Jolly, has explained, this amendment seeks to put the service police within the remit and jurisdiction of the Independent Police Complaints Commission.

We do, of course, support the need for independent oversight and scrutiny of the Royal Navy Police, the Royal Military Police, and the Royal Air Force Police, including the key objective of having an independent mechanism to investigate complaints against them. I am also aware that Her Majesty’s Inspectorate of Constabulary has recommended that the Government should consider further whether the IPCC could be the appropriate mechanism.

The Government have given early consideration to this, including discussions with the IPCC. To bring the service police under the remit of the IPCC is potentially a major change. Although only a small number of cases may be involved, it could mark a significant shift for the IPCC far beyond its current operations in England and Wales. As the chair of the IPCC has said,

“There are inherent and significant differences between the remit and jurisdiction of the service police and those of the Home Office Police forces”.

In addition, the IPCC is currently part way through a major programme of expansion to build its capacity and capability to investigate all serious and sensitive allegations against civilian police forces. This Bill will further strengthen the IPCC’s remit and powers and, in light of its expanded role, the Bill also provides for the reform of the organisation’s corporate structure and governance to deliver a more capable and resilient organisation.

At this stage, the IPCC’s capacity for further change to its role is constrained. That is why the Government, led by the Ministry of Defence, are seeking alternative options. Recent work with the Ministry of Defence has been focused on the development of a common complaints procedure across the three service police forces. This procedure covers complaints made by serving and non-serving military personnel against a member of the service police carrying out a policing function, irrespective of location. There is now also a protocol between the service police forces to ensure that, where there may be a conflict of interest around the investigation of a complaint, one service police force may investigate another. The next phase of the Ministry of Defence’s work is to consider how best to introduce a mechanism that will provide for the independent oversight of these complaints, wherever in the world they are made.

I hope that the noble Baroness will understand that, in the light of the work being taken forward by the Ministry of Defence, and the risks that could arise if we sought to impose new responsibilities on the IPCC at a time when it is already going through a substantial reform programme, I cannot commend this amendment to the Committee. I accept, however, that the noble Baroness wants to see more progress towards finding a long-term solution to this issue. I can certainly undertake to write to the Armed Forces Minister to draw his attention to this debate, but for now I ask the noble Baroness to withdraw her amendment. Of course, I am more than happy to meet the noble Baroness.

[Baroness Jolly]

I thank the Minister for her comments and my noble friend Lord Paddick, and the noble Lord, Lord Rosser, for their support. I understand that it would be a large change for the IPCC to undertake this extra work. I imagine that a certain amount of the capacity would go from one organisation to the other. One of the things I would like to understand is the timescale of all this, so perhaps when the Minister and I meet, this is the sort of area we could discuss.