Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Baroness Thornton

Lords Hansard - Part 2 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we have had an important debate here, and I thank the noble Lord, Lord Warner, both for bringing these amendments before the House and for explaining their background and the important role of the Select Committee. We have debated it several times in your Lordships’ House and everybody in the House, apart from the Government Front Bench, it seems, thinks it is a brilliant report that should be acted on. This seems to be an opportunity for the Government to take on board some of its major recommendations, and this is one of them. We would support that, and we hope that the Minister might have some good news for us on that.

I also wish to speak briefly to the amendment in the name of my noble friend Lady Merron. The argument has already been made by other noble Lords—I am having a slight sense of déjà vu because I am sure I made a speech along the same lines in 2011—about the importance of Public Health England having a statutory basis to its work to give it transparency and accountability. The last two years must show us that that is the right thing to do. That is why I agree with my noble friend’s amendment to put the new UK Health Security Agency on to a statutory footing. As far as I can tell, in the past 20-odd years since I came to your Lordships’ House, every time that various Governments have mucked about with public health, they have got it wrong. Let us use this opportunity to get it right.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I thank noble Lords for bringing forward and explaining these amendments tonight. The specific functions that noble Lords describe in Amendments 225ZA and 285 are crucial functions that the Government are committed to ensuring are discharged in full. There are, however, several bodies in place that already fulfil these proposed functions.

The first proposed function would be a monitoring role and a duty to publish data. This important function is undertaken by the Department of Health and Social Care, which already monitors and publishes some of the data described in the proposed amendment; specifically, that relating to disease profiles, but also incorporating demographic trends, where relevant. The department also commissions independent academic modelling from the Care Policy and Evaluation Centre, or CPEC, to produce projections of the long-term demand on adult social care services. The CPEC model is updated regularly to reflect the latest available academic research and evidence, as well as important updates to key inputs such as ONS principal population projections, along with life expectancy and mortality rates, disability rates, household composition, availability of informal care and unit costs of care.

The second proposed function involves assessing the workforce and skills mix. We agree that workforce planning is a vital component behind any investment. We agree, therefore, that the assessment referred to in this function is extremely valuable. It is undertaken at present by the Department of Health and Social Care, working collaboratively with both Health Education England, or HEE, and NHS England. They work together to look at key drivers of workforce demand and supply over the long term, and will set out how these may impact on the required shape of the future workforce in its broadest sense to help identify the main strategic choices facing us, develop a shared and explicit set of planning assumptions, and identify the actions required.

There are two reasons why I have concerns with trying to involve another body in workforce planning, as this amendment suggests. First, I fear the new body proposed by noble Lords would be distant from planning decisions within the NHS and the needs of service delivery. The strength of the intention to merge Health Education England and NHS England is to tackle this very issue. Secondly, it would overlap and duplicate HEE’s existing statutory responsibilities for workforce planning and investment. To support this work, the department commissioned HEE in July 2021 to refresh its long-term strategic framework, Framework 15.

Moving on, the third proposed function focuses on the stability of health and adult social care funding. This Government are committed to funding stability and sufficiency, underlined by our decision to enshrine in law our five-year long-term plan funding settlement. Healthcare budgets are agreed at spending reviews, with the Office for Budget Responsibility scrutinising those budgets. Further independent financial assessment is therefore not necessary.

It is clear that, for each of the proposed functions, there are already well-established bodies and processes to safeguard the long-term sustainability of an integrated health and adult social care system for England, underpinned by reporting to Parliament. We do not think that the creation of a further body would add value.

I fully agree with the sentiment behind Amendment 281. The UK Health Security Agency, or UKHSA, must be fully accountable for its activities, and there should be full transparency as to how it operates. I can give reassurance, however, that the establishment of the UKHSA as an executive agency of the Department of Health and Social Care is the most appropriate model.

I assure your Lordships that we fully explored other organisational models. However, the executive agency model best facilitates a balance across the needs for strong operational delivery capability, scientific integrity, and the ministerial oversight and accountability necessary to command public confidence. The executive agency model allows for the delivery of executive functions of the department to be carried out separately from, but within a policy and resources framework set by, the department. As the noble Baroness will recognise, this level of flexibility is critical to ensuring a quick and effective response to Covid-type threats without needing to rely on legislation to confer functions, which this amendment would require. Any other approach would reduce the ability of the UKHSA to respond flexibly and rapidly.

In line with requirements for all executive agencies, multiple arrangements are in place to ensure accountability, transparency and effective governance for UKHSA. These include the framework document, which is soon to be published; the annual remit letter, published on 13 July; the business and strategic plans to be published each financial year; and quarterly accountability meetings. Also, UKHSA is required to publish information on contracts and expenditure under normal government transparency rules. As an executive agency, UKHSA must publish annual reports along with audited accounts after the end of each financial year.

It is for these reasons that I ask noble Lords not to press their amendments.

Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Baroness Thornton

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

Well done. You need Baronesses to do this: they get to the point and get it done.

I thank noble Lords for explaining these amendments. As they may recall, in 2012 we abolished the private patient cap while clarifying that the foundation trusts’ principal purpose is

“the provision of goods and services for the purposes of the health service in England”.

This means that foundation trusts must make the majority of their income from NHS activity and must always have as their primary purpose the delivery of NHS services. We also retained the requirement that additional income should be used to benefit NHS patient care, and it has been used across the system to offset such things as maintenance costs, to finance alternative transport such as park and-ride and to fund patient care.

This amendment would introduce a new cap by requiring foundation trusts to agree with their ICB and ICP their income from non-NHS sources. However, this would be a significant bureaucratic burden on foundation trusts and would require them to forgo raising additional income or seek agreement via a multi-stage process before doing so. It would also mark a significant new restriction on foundation trusts’ freedoms and autonomy.

Similarly, Amendment 233 would restrict the freedom of NHS organisations to decide locally the most appropriate structures they need to support their operations. There are multiple reasons for trusts setting up subsidiary companies, including providing services for other trusts and being able to attract staff from the local employment market. Creating a subsidiary can also be an alternative to outsourcing services to the private sector, thereby maintaining its staff within the NHS family. Importantly, in November 2018 NHS Improvement issued guidance to trusts about forming or changing a subsidiary. Under that guidance, all subsidiary proposals must be referred to NHS Improvement for review. NHS England and NHS Improvement paused their update of the guidance to trusts on subsidiary companies to allow the sector to focus on supporting the response to Covid-19 and the recovery of services. However, we remain committed to the review and the publication of this updated guidance is now set for early summer 2022.

I hope I have given the noble Baroness sufficient reassurance for her to withdraw the amendment.

[Baroness Thornton (Lab)]

I thank the Minister and am very pleased indeed to hear about the review. However, we on this side of the House believe that the NHS should be the default provider of clinical services and, if it is not the only provider, it should be the predominant one in geographical and service terms. That means that there must be investment in the NHS, not in the private sector. It is that balance, which we must ensure is in this Bill, that has protected NHS clinical services in the past.

I will read what the noble Baroness has said very carefully, and I might need further reassurance in due course. I beg leave to withdraw the amendment.

Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Baroness Thornton

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I agree with my noble friend Lord Hunt and those speakers who expressed their concern about the open-endedness of what is in the Bill at the moment and the lack of protection for patient data. I look forward to the Minister’s reply on this.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I am grateful to the noble Lord, Lord Hunt, particularly for his brief and, as always when he speaks, his clear understanding of the amendment. It makes it so much easier for us to know where the noble Lord is coming from.

I am grateful to all other noble Lords who spoke on this issue, and I understand the interest in the integrated care boards’ power to disclose information that is personal data. As the noble Lord, Lord Hunt, mentioned, public trust is essential in this and individuals’ data will be used lawfully and with respect, and held securely with the right safeguards in place. It will need to be proportionate, transparent and subject to individuals’ rights to access and correct information in use.

Let me further explain how we will make sure this happens. I assure noble Lords that the clause already restricts integrated care boards’ powers to disclose information by limiting these to the specific circumstances set out in the clause. Further, all use of personal data is subject to data protection legislation, including the UK general data protection regulation and the Data Protection Act 2018. This legislation provides several key protections and safeguards for the use of an individual’s data, including strict rules and key data-protection principles for the sharing of personal data.

Under the UK GDPR, health data has to be treated as a special category. This data requires additional protections due to its obvious sensitivity. For this type of data to be lawfully processed, a further condition must be met, in addition to identifying a lawful basis, as set out in the GDPR and the Data Protection Act.

This data protection legislation applies to the use of all personal data and provides robust safeguards in relation to information and disclosure. Importantly, there are additional protections on the use of health data, including the common-law duty of confidentiality, along with the role of the National Data Guardian, who advises and challenges the health and care system to help ensure that the public’s confidential information is safeguarded securely and used properly. As the noble Lord, Lord Hunt, mentioned, there are also the Caldicott principles; there are seven of these, which I am sure noble Lords are aware of, so I will not go through them all now. They provide guidance to health and care organisations on the use of confidential information. Along with this, there is also the national data opt-out.

I remind the Committee that new Section 14Z61 will apply, which provides when an ICB may disclose information obtained by it in the exercising of its functions. I emphasise that maintaining trust that healthcare data is being used properly is paramount. Individuals’ data will be used lawfully and with respect, held securely and have the right safeguards in place. None of the changes we are making will remove the duties of organisations to comply with the requirement of data protection legislation. Along with that, we are working with the Home Office to ensure that the protection and confidentiality of patient information is upheld within the Police, Crime, Sentencing and Courts Bill. Appropriate safeguards are in place and the Bill makes it clear that information can be shared only in accordance with data protection laws.

I am concerned that this amendment could cut across the different pieces of relevant legislation, preventing the ICB from effectively discharging its functions where it may be necessary to disclose information, which may include personal patient data. This would include investigating complaints, making safeguarding referrals for patients whose welfare is at risk, complying with court orders and assisting criminal investigations. It would also risk a confusing data-sharing system, with different rules applying to different organisations.

I know that my noble friend the Minister, the noble Lord, Lord Kamall, has agreed to talk about this further with the noble Lords, Lord Hunt and Lord Clement-Jones. He wants to meet civil liberties organisations, along with them, to discuss this subject further. However, I regret that the Government cannot accept this amendment. I hope that I have given the noble Lord some reassurance and that he will feel able to withdraw the amendment.

Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Baroness Thornton

Committee stage
Thursday 20th January 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I am delighted that my noble friend Lord Howarth has brought this suite of amendments in front of the Committee and is bringing the wealth of his experience to our debates on the Bill. He is a great proponent of the role and value of the non-clinical services in healthcare and well-being, and quite rightly too. It would be great if, somehow or other, this could be recognised in whatever comes out of our considerations, though I challenge the Minister to tell us how we might do that.

We support the amendments in this group to establish a role for wider considerations beyond remedial, interventionist clinically-led care. Amendment 90 covers housing. The role of decent housing in good health and in tackling health inequalities cannot be overestimated. Amendment 103A would require IBCs to consult on youth health prevention and treatment through an advisory board consisting of young people. All these amendments have huge merit.

I know that we will have a wider discussion about the role of the voluntary sector and social enterprises in provision of healthcare in a later group. However, voluntary and community organisations and social enterprises have been central to the delivery of non-clinical services in healthcare and well-being, particularly during the pandemic.

[Baroness Chisholm of Owlpen (Con)]

My Lords, before I respond on this group, I want to apologise for the chaos that I caused at the beginning of this Bill today. I hope that noble Lords did not think I was being discourteous to the House. Luckily, next Wednesday, normal services will be resumed when my noble friend Lady Penn is in her seat.

I am grateful to the noble Lord, Lord Howarth, and other noble Lords for bringing this suite of amendments before the Committee. It was interesting that several noble Lords brought up my noble friend the Minister’s band, Exiled In Brussels, which I think he is now going to rename “Exiled From Brussels”. I can say that there is a YouTube clip of the band which my noble friend said he is willing to send out to everybody, so that is something to look forward to.

On Amendment 59, I recognise the noble Lord’s concern to ensure that the voluntary, community and social enterprise sectors are represented in the Bill. I understand the intention of his amendment. I certainly acknowledge the important work of these sectors and their contribution to our health system. I am sure that we all have examples of how these non-clinical services are of benefit to our health system.

However, our intention, quite rightly, is to use the Bill to set out a framework of duties for ICBs that ensures they fulfil their functions effectively while avoiding being overly prescriptive. The provision in question sets a clear requirement on ICBs to discharge their functions in a way that promotes continuous improvement in the quality of services, particularly in health outcomes.

The intention is to establish a culture of continuous improvement in everything the ICB does, but, importantly, leaving ICBs to decide how this will work for them. Setting specific parameters, as this amendment seeks to do, would in practice narrow the focus of how they may look to improve the quality of services. This may be to the detriment of taking a more holistic approach to how to improve the quality of services. That said, the current drafting of the provision would not prevent ICBs engaging providers of non-clinical services, including those mentioned in the amendment of the noble Lord, Lord Howarth of Newport. Indeed, we would expect that, where appropriate, ICBs would consult with relevant stakeholders, such as those from the voluntary sector, to ensure continuous improvement.

Turning to Amendment 69, co-production, where people, family members, carers, organisations and commissioners work together as equal partners to design and deliver services, is an important principle, and one that we would expect ICBs to champion. This is reflected clearly in NHS England’s draft implementation guidance on working with people and communities, which also sets out several practical steps ICBs should consider to appropriately promote and embody co-production. This includes visibly supporting and sponsoring co-production, and supporting the adoption of co-production approaches where appropriate. I feel it is important to point out that mandating co-production in all circumstances risks narrowing the duty and may lead to other valuable methods of involvement being marginalised. Therefore, while it will often be a desirable aim that we would expect ICBs to pursue, it may not be appropriate in every case, and we want to allow ICBs and patients discretion to determine what is best in their area.

I will address Amendments 71 and 77 together. I am grateful to the noble Lord, Lord Howarth, and the noble Baroness, Lady Greengross, and I appreciate the interest in including social prescribing in the Bill. On Amendment 77, I begin by assuring noble Lords that the Government are absolutely committed to the rollout of social prescribing in line with the NHS Long Term Plan commitment. The plan was to have 1,000 new link workers in place by 2020-21, a target which I am pleased to say has been exceeded, so that we now aim for at least 900,000 people to be able to be referred to social prescribing by 2023-24. As of September 2021, there were at least 1,582 social prescribing link workers in place. Furthermore, in relation to innovation, the Government have set up the National Academy for Social Prescribing, in line with our manifesto commitment, which has continued to support the expansion of social prescribing and promote innovation in health and well-being across all sectors.

The duty to patient choice should be considered by ICBs as part of the broader move towards more integrated, population health-management approaches. This requires embedding more personalised care models that enable patient choice and also consider non-clinical approaches, in line with the NHS Long Term Plan. This commitment is to make personalised care business as usual across the health and care system. Social prescribing and community-based support is already a core component of the NHS’s comprehensive model of personalised care. I hope I have reassured noble Lords of the progress being made and work being done on social prescribing and that they will feel able not to press these amendments.

I turn next to the amendments proposed by the noble Lord, Lord Howarth, and the noble Baroness, Lady Bennett of Manor Castle, which would insert a number of references to the voluntary community and social enterprise and creative and cultural sectors. This Government hugely value the contributions of the voluntary community and social enterprise sector, including creative and cultural entities, to the health and well-being of the nation, and recognise their important role in integrated care systems. However, we feel that the amendments are not necessary, as their intended effect is already possible through provisions within the Bill.

A key principle of the Bill is the legislative flexibility to empower local leaders to develop bespoke solutions to meet specific local needs. This principle is reflected in the current drafting of Clause 20. Several of these amendments would have the effect of being overly prescriptive in areas where we would already expect the VCSE sector to play a key role.

I assure noble Lords that many of these concerns will instead be addressed in guidance. NHS England and NHS Improvement have published guidance relevant to ICBs on partnerships with the voluntary community and social enterprise sector, outlining the importance of the VCSE sector as a key strategic partner in local health systems. It provides guidance on how VCSE partnerships should be embedded in how the ICBs operate. Furthermore, the guidance sets out that, soon after they are established, ICBs will be expected to develop a formal agreement for engaging and embedding the VCSE sector in system-level governance and decision-making arrangements.

I turn to related Amendment 80. I know that the noble Lord, Lord Howarth, has a special interest in this issue, and I listened with interest to his speech at Second Reading on the work of the National Centre for Creative Health, which he chairs. Research is very important, and I am pleased to say that the department funds research in this area through the National Institute for Health Research. The NIHR funds and supports a range of research conducted by multidisciplinary researchers from diverse fields, including social sciences, behavioural sciences and the humanities. For example, the MODEM project, jointly funded by the NIHR and UKRI, reviewed evidence on music therapy and identified that a structured programme of music therapy given by a trained therapist can reduce agitation among people with dementia—which I think the noble Baroness, Lady Tyler, mentioned in her speech.

We do not consider it appropriate or necessary to specify particular research areas in primary legislation. In addition, we expect that ICBs will already promote a range of research, including those on non-medical interventions, and the noble Lord already cited in his Second Reading speech where this has been done by existing integrated care systems.

On Amendment 82, the Government place the utmost value on supporting the health and well-being of NHS staff. We are taking a range of actions to ensure that this remains a priority across the health and care system, and we do not believe that a legislative duty is needed in this area. Over the past two years we have seen as never before the intense pressures on the workforce, and we recognised at an early stage the toll that this may place on the mental health and well-being of health and care staff, with a clear need to prioritise enhanced well-being and mental health support for all NHS and social care staff. We all know that the whole country owes these staff an immense debt of gratitude.

At a national, strategic level, the People Plan, published in July 2020, puts NHS staff health and well-being at its core and ensures that all NHS staff have access to a comprehensive psychological and emotional support package. This includes a dedicated support line that is available for staff 24/7, and free access to mental health and well-being apps. Alongside this, 40 dedicated mental health hubs have been established and are accepting referrals across the country to proactively identify at-risk people and groups and focus on staff with more complex needs, ensuring that they receive rapid access to evidence-based mental health services. To ensure that this offer continues to improve staff mental health throughout 2021-22, an additional £37 million has been invested in 2021-22, building on the £15 million in 2020-21. I hope that the noble Lord, Lord Howarth, will accept that this work is worth while and important and will continue without the need for legislative amendment.

Patient Safety Commissioner

Debate between Baroness Chisholm of Owlpen and Baroness Thornton

Thursday 2nd December 2021 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

I am sure there are hopeful candidates waiting. I am afraid I have no idea who they are—obviously, that is not within my remit. I agree with the noble Baroness that we need to get on with this. I think the department realises that and is concentrating on moving this forward.

[Baroness Thornton (Lab)]

My Lords, I think it is worth reminding ourselves of the problem: we need a patient safety champion because many patients, particularly women, were disregarded and dismissed for many years by those across the whole of our NHS. This was graphically and effectively exposed by the report from the noble Baroness, Lady Cumberlege. Will the commissioner report to Parliament, and how will we ensure—I say “we” because I think we all have a responsibility in this regard—that their independence is safeguarded and their status protected?

[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.

Mental Health

Debate between Baroness Chisholm of Owlpen and Baroness Thornton

Tuesday 27th February 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for her Statement. I declare an interest as a lay member of a CCG.

I think we would all agree how disappointing the CQC’s Mental Health Act report is, given that the CQC found that there has been limited—or no— improvement in key concerns which it raised in previous years, and given that the number of people detained under the Mental Health Act continues to rise. Added to that, last week’s analysis by the Royal College of Psychiatrists found that mental health services have less money to spend than they did in 2012. That does not weigh with what the Minister was saying about the amount of money going into mental health services. How will the department address that failure? I accept that there is a review going on. That is very important and we support it. There could not be a better person to lead it than Sir Simon Wessely—there is no question about that. However, there seem to be some immediate problems, one of which is whether the money allocated to mental health services is actually spent on mental health services. What do the Government intend to do about that? Indeed, will the Government pledge to ring-fence mental health spending so that the money is not siphoned off to be used elsewhere in the system?

[Baroness Chisholm of Owlpen]

I thank the noble Baroness for her question, and indeed, some of the CQC report is disappointing. That is why it is so important that it is working with Sir Simon’s review to feed its thoughts into the review. I know that he will take a terrific interest in what it says.

As to ring-fenced funding, there was an overall increase in spending of £11.6 billion, which was up 8.4% since 2014-15. NHS England has strengthened the mental health investment standard in its planning guidance. This means that as of 2018-19, every CCG will be required to increase its spend in excess of its overall increase in funding. Commissioners must be given the freedom to make decisions about the needs of their population. At the moment, we believe that the investment standard strikes the right balance in allowing that freedom while ensuring that crucial mental health services are properly funded. However, I believe, as the noble Baroness said, that the review will look into this. It is very important that the money going to the commissioners is spent on what it is meant to be spent on.

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

Debate between Baroness Chisholm of Owlpen and Baroness Thornton

Wednesday 6th December 2017 Grand Committee

[Baroness Chisholm of Owlpen (Con)]

My Lords, I thank the rebalancing programme board for its advice, which has formed the basis for this order. The purpose of the order is to create, for registered pharmacy professionals working in a registered pharmacy, new defences to the criminal offences set out in Sections 63 and 64 of the Medicines Act 1968. The order makes these defences available in defined circumstances to pharmacy professionals making genuine dispensing errors. This marks an important step forward in addressing barriers to providing a safer, higher-quality service.

The Mid Staffs inquiry highlighted the importance of putting patient safety at the heart of everything we do and taught us about the importance of achieving a careful balance between assuring accountability to the patient and developing a culture of openness and transparency so that we learn from errors, improving practice and safety. Indeed, Professor Berwick stated:

“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care”.


The order follows that philosophy. Pharmacy professionals are highly regulated—in relation to dispensing errors, more so than any other healthcare professionals. Indeed they are subject to “triple jeopardy” in the event that they commit a dispensing error. They face prosecution for strict liability offences under Sections 63 and 64 of the Medicines Act 1968, prosecution for offences under general criminal law and sanctions under professional regulation requirements.

This can lead to defensive practices. It has been demonstrated in other industries where safety is critical that working under such a threat of sanction is a hindrance to the reporting of errors and accidents and therefore wider learning. Evidence suggests that patient safety and service quality can be improved through increasing the rate of reporting and learning from dispensing errors. This will have benefits to patients locally and throughout the NHS system.

By removing the fear factor of a strict liability offence for inadvertent dispensing errors, we aim to create a much more open and transparent culture, which in turn should help to improve learning and prevent mistakes from happening. We will work closely with pharmacies’ professional and regulatory bodies across the UK to make this a reality. That said, registered pharmacies already have a range of systems and procedures in place to prevent dispensing errors occurring. More than 1 billion prescription items are dispensed every year and it is testament to the professionalism of pharmacy staff that errors occur only in a small proportion of cases.

However, dispensing errors can occur within a registered pharmacy for a variety of reasons. For example, there are many thousands of medicines and some have similar names and brandings; medications may also have complicated dosing schedules. But this order is not about accepting the inevitability of error. Instead, it seeks to ensure that we collect information on errors that do occur and think hard about how they can be prevented in future, including through spotting trends at a national level. This may involve improving systems and procedures, designing out error as far as practicable. Obviously, without knowledge of what has gone wrong, this will not be possible.

However, we are not removing all safeguards for patients. There will remain offences under general criminal law—for example, in cases of gross negligence and manslaughter—and sanctions under professional regulation. In such circumstances, the professional regulators—the General Pharmaceutical Council and the Pharmaceutical Society of Northern Ireland—can still subject individuals to regulatory fitness-to-practise procedures. Sanctions would depend on the circumstances of the error but could ultimately include the individual being removed from the professional register and no longer being permitted to practise.

The order is well supported. During the public consultation, it was overwhelmingly endorsed, including by patients and the public, and groups such as Action against Medical Accidents. They will now want to see pharmacy professionals play their part and demonstrate increased learning and reporting of errors. The Government are committed to ensuring that this happens and we have already taken some action in this regard. In each of the four home nations, a number of initiatives to support reporting and learning have been introduced; for example, medication safety officers or champions, and national reporting systems. Regulatory and professional bodies in pharmacy have also put in place standards and guidance to support the desired culture change, with community pharmacy trade bodies encouraging their members to follow the standards and encouraging pharmacy teams to report, learn, act, share and review.

Action is also being taken in each of the home nations on medication error more generally throughout the healthcare system. It is sobering that 5% to 8% of all hospital admissions are medication-related. This September, the Secretary of State for Health and the Chief Pharmaceutical Officer for England launched an initiative that focuses on reducing prescribing and medication errors throughout the National Health Service in England. The programme will look at a number of areas, including improving how we use technology, understanding how best to engage patients with their medicines, and advancing the transfer of information between care settings.

Finally, I make it clear that while the order provides a defence for pharmacy professionals working in registered pharmacies, it is important to recognise that pharmacy occurs outside these settings and therefore not all pharmacy professionals will be able to avail themselves of the defences set out in the order. So work is progressing to develop similar measures for pharmacy professionals working in hospitals and other care settings, and we intend to consult on this early next year. This will ensure that, regardless of their position within the healthcare system, pharmacy professionals will be encouraged to report and learn from dispensing errors.

In summary, the order supports improved patient safety by encouraging a culture of candid and fulsome contributions from those involved when things go wrong. Within this culture, pharmacy professionals can increase their learning from dispensing errors and identify mitigating action to make recurrence less likely in the future. I commend the draft order to the Committee.

[Baroness Thornton (Lab)]

I thank the Minister for introducing this order with such clarity, and in the process answering several of the questions I had intended to ask her, which may shorten the proceedings. As she said, the order makes a change to the legislation governing the way in which pharmacists who make a mistake are prosecuted, by making certain new defences available to them. As the Minister also said, at the moment they face triple jeopardy from their professional regulator, health legislation and, potentially, criminal law for manslaughter. I recognise that this order is based on the premise that reducing the risk of prosecution will increase the number of errors reported. Over time, we hope that learning from a greater number of errors should lead to improvements in practices and therefore enhance patient safety.

The order will offer protection to pharmacists and dispensing technicians, but its main purpose, quite rightly, is to improve patient safety. Proposed new Section 67B(5) will require the accused to prove in their defence that on discovery of the error, every step was taken to report it at the earliest opportunity to the person in receipt of the medication. That provision will give pharmacy professionals the chance to minimise the effect of errors and will positively incentivise them to admit them, as the act of so doing will aid their defence. This is therefore a new duty of candour, which has the potential to lead to major cultural change. As the Minister also said, this does not mitigate pharmacy professionals who show deliberate disregard for patient safety and who will not benefit from this defence. The order will protect only those practising in registered premises who are already subject to professional regulation. For the sake of the protection of patients, it will not provide a defence for other groups or individuals external to the registered premises and involved in the medical supply chain.

It has to be said that this has been a long time coming. I recall the issue being raised in 2009, and I was there when, during the passage of the Health and Social Care Act in 2011, the noble Earl, Lord Howe, said that the legislation needed to be reviewed so that criminal liability did not arise as a result of genuine dispensing errors. While we welcome this order as a step in the right direction, we therefore feel that it does not go far enough and we hope that it does not take as long as it already has to complete this project.

Even after it is implemented, pharmacists will still not be on a level playing field with other healthcare professionals; they may benefit from access to improved defences, but, as the Pharmacists’ Defence Association maintains, they will still face the prospect of a police investigation and a lengthy trial. They will have to hold on to the hope that they can successfully use the defences but may still face prosecution under other provisions of the 1968 Act. I hope that the Minister will consider further legislation to ensure that inadvertent errors are totally decriminalised. Why are we still asking that those errors should be decriminalised? I hope that the Government will move on this.

Is there some kind of omission in the order? We know that learning from reported errors is anticipated, but there is no formal requirement in the order to deliver on that. It is reliant on good will. I am sure that many pharmacists and pharmacy dispensary technicians will want to take it upon themselves to improve their existing protocols so that errors cannot reoccur, but there is no formal requirement in the order for them to so do.

I am pleased to learn that hospital pharmacies, which are not included in this but should be, because there are many such pharmacies, will be included in due course. We support that very much.

As acknowledged in the Department of Health consultation report, the risk of prosecution under Section 269 of the Human Medicines Regulations 2012 for inadvertent labelling errors still remains for pharmacy businesses. In fact, since a pharmacy business cannot be put in jail, it seems that the risk is to pharmacy owners, who may also be pharmacists.

Finally, the Department of Health has projected a 100% increase in error reporting and a 30% reduction in errors. On what basis has it arrived at those conclusions?