Health and Care Bill

Baroness Kramer Excerpts

Committee stage
Wednesday 9th February 2022 Lords Chamber

The concerns that I and other noble Lords are raising about the powers of the Secretary of State to direct investigations and the erosion of the safe space are not something we have just dreamt up. The Government have received representations from several groups of leading experts, the current HSIB advisory panel, HSIB executives and members of the Joint Committee that previously scrutinised the original draft Bill, as well as from harmed families. Can the Minister tell the House why such senior, extensive and unanimous advice on these issues seems to have been ignored?

[Baroness Kramer (LD)]

My Lords, this is my only intervention on this Bill, and I will limit myself at this hour to speaking to my own Amendment 309A, which deals with whistleblowers. I want to make a slight distinction from the safe space discussion, because for very many whistleblowers, if not the overwhelming majority, safe space becomes an irrelevance. They have raised their issues with their colleagues and with management. They have often raised the issues in very public settings and have been identified. Sometimes—often, in fact—the information they have is so particular that they can be identified easily by the organisation from the issues on which they are speaking out.

When I looked at this Bill, I was absolutely stunned to see that we were creating a Health Services Safety Investigations Body without any mention directly of whistleblowers and just some minor reference to disclosure. I am afraid that this tells us something about the attitude of those in charge of the health sector, and sometimes that of the Government and Ministers.

Whistleblowers have been absolutely key to exposing scandal after scandal but are treated quite disgracefully by the system. Typically, they are ignored or disbelieved, often for years—and that is when they go out beyond even a safe space, if that is available to them, and begin to talk to the media out of desperation to make action happen. Attempts are then made to silence them, typically by the offer of settlements that contain aggressive non-disclosure clauses, called confidentiality clauses here in the UK, which are both common and very aggressive within NHS settlement agreements. Many whistleblowers are subject to aggressive retaliation, requiring them to fight for as long as seven years through employment tribunal systems just to clear their names and sometimes be awarded some compensation for a career completely destroyed.

Yet without whistleblowers, failures in healthcare, whether from incompetence or abuse, would rarely be exposed and would remain hidden for much longer. Let me repeat what I have often said before: whistleblowers are the citizens’ army that provides crucial information to regulators and enforcement bodies. They are the canaries in the mine that the HSSIB will need. If it treats them with respect and—even more importantly—protects them, they will provide deterrence, which is always better than cure.

When I raised this with Ministers, the answer I was given is that whistleblowers are protected in the healthcare system by the National Guardian’s Office and some 800 “freedom to speak up” guardians put in place after the damning Francis report in 2015. Guardians are typically NHS trust employees, already busy but taking on additional duties. Ministers may say that over 20,000 cases were raised to such guardians last year, but the guardians, no matter how much they might have wished to do, in most cases have been able to do little more than provide advice and direct people to various channels of reporting. Unfortunately, the guardian system has no power to enforce action following a disclosure and no tools to protect a whistleblower from retaliation. “Guardian” is a misnomer.

There is no time today to go through the individual cases of whistleblowers as each is incredibly complex. I have in my pile of papers evidence from seven very different whistleblowers, which I will summate. Dr Kevin Beatt and Dr Raj Mattu are leading cardiologists. There is no way they could have reported their complaints in a safe-space system; they would immediately have been identified as those who are bringing forward the issues. Mr Peter Duffy is a urological surgeon, Mrs Sue Allison is a radiographer, Dr Chris Day is a junior doctor, Steve Turner is a nurse and lecturer and Dr Ed Jesudason is a paediatrician. Between them, they spoke up on issues including a cover-up of preventable children’s deaths, understaffing and overcrowding, unsafe surgery due to specialist staff shortages, lax attendance by senior doctors, bullying and blacklisting.

Every one of those seven suffered terrible retaliation. Some are still fighting, some have been vindicated after long, bruising struggles and one has even received an MBE, but they are the tip of the iceberg. From speaking to just one civil society group, WhistleblowersUK, I found that it was inundated by calls from whistleblowers last year, who had found no adequate response from the National Guardian’s Office or the Care Quality Commission.

My amendment gives the HSSIB responsibility for setting in place a secure process for whistleblowers to report safely and confidentially any concerns on patient safety. In a sense, you could look at it as a safe space arena. It also requires transparency, at least in aggregate, about how the HSSIB acts on that information. The amendment goes well beyond a safe space, which is a reflection of the current Public Interest Disclosure Act, by offering confidentiality to everyone, not just employees. It also requires the HSSIB to report any retaliation against whistleblowers to the Secretary of State.

I hope the many whistleblowers who are suffering acute detriment under the current system or are too afraid to speak out can read Hansard tomorrow and hear from the Minister some positive and powerful responses to this amendment.

[Baroness Neuberger (CB)]

My Lords, I am also rather nervous. I spoke at Second Reading about how worried I was by the exclusion of the ombudsman—the PHSO—from the provisions to create a safe space for investigations carried out by the HSSIB. The safe space is of enormous significance, although I agree with the noble Baroness, Lady Kramer, that there is an issue about where whistleblowers fit—that is right. We need the safe space but, as currently drafted, the Bill cuts across the unique and long-standing role of the Parliamentary and Health Service Ombudsman to investigate complaints about the NHS. Although I take the point of the noble Baroness, Lady Young of Old Scone, that the number of cases are very few, there is a constitutional principle here.

Queen’s Speech

Baroness Kramer Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Kramer (LD)]

My Lords, as the first of the winders, I hope that the House will not mind if I narrow my remarks, because it has been a long day and I know that people have trains to catch. As I listened to the debate, there was one overwhelming theme that was repeated in speech after speech. It was a focus on public services. I think that the House will agree that the public have the same focus on those services. It is one of the most significant ways in which they will be judging the Government, and they have very high expectations.

The Minister led off those expectations by talking about significant additional spending on public services, but as I listened to comments made all around the House, one had to come to the conclusion that looking only at funding is not enough. The largest commitment of money is obviously to the NHS. It will be on a multiyear basis and it was welcomed over and over again, but, as the right reverend Prelate the Bishop of London pointed out, that amount of money does nothing more than stabilise the NHS. I think that expectations are higher, and I suggest that the Government should think that through.

Additional money will also be made available for schools, but, as the noble Lord, Lord Griffiths, pointed out, as did the noble Baroness, Lady Blower, in her excellent maiden speech, that money merely restores cuts—and does not even restore them completely. As my noble friend Lord Storey pointed out, at this moment in time we have a bulge of children going through the school system, and we have a dearth of teachers. Surely another look has to be taken at the adequacy of funding for the schools budget.

The most speakers addressing this issue spoke of the need for more money for social care. We listened to the noble Lord, Lord Dubs, pointing out that £1 billion in new money was pretty inadequate when the need was for £8 billion. Frankly, the noble Lord, Lord Forsyth, whom I do not normally turn to when it comes to demanding additional money for a public service, absolutely hit the nail on the head—the noble Lord, Lord Horam, pointed out exactly that he did—when he said that the Government would have to write a big cheque to solve this problem.

As I look back on my own Benches—and not only my own Benches—I note that the whole range of public services outside the big three that were the focus of so much discussion, such as local government, policing, prisons, local transport and planning capacity—which, as the noble Earl, Lord Lytton, pointed out, leaves a lot of the housing industry with serious problems—have been cut to the bone. In both the Conservative manifesto and the Queen’s Speech, the austerity in those areas has become embedded. It is not turning around but becoming fixed on a permanent basis.

When we look at issues of welfare and benefits, it once again looks as though austerity is becoming embedded. It is not the beginning of a process of change or the end of austerity for those areas. The noble Baroness, Lady Greengross, my good and noble friend Lady Janke, the right reverend Prelate the Bishop of Portsmouth and others pointed out that the working poor are now a very large percentage of our population. They will not be relieved by a £2 per week reduction in national insurance contributions. I also point out that, while I very much welcome increases to the minimum wage, for the working poor, much of that will be clawed back by an offsetting cut in benefits.

As the noble Baroness, Lady Drake, said, the weakness we have in household resilience really reflects some of the fragile circumstances of so many of our fellow citizens. This Government will have to think again to understand whether they have identified the appropriate resources to tackle those fundamental problems.

Part of the Queen’s Speech sets a fiscal rule of having the budget in balance in three years. That is not an unreasonable goal where—here is my caveat—the Government are open to tax increases to make sure that the necessary public spending can happen, but borrowing is kept appropriately contained. But this Government have committed to no increase in income tax, national insurance contributions or VAT, and have made a very tepid decision to keep corporation tax at 19% when they could very comfortably have raised it to 21%, for example, without undermining UK competitiveness at all. I do not join the noble Lord, Lord Flight, in hoping for further tax cuts. I am with the noble Lords, Lord Tugendhat and Lord Horam, in saying that the Government need to be open to the possibility of raising taxes to achieve the fundamental programme that this country needs.

I will make just a couple of comments on business aspects, because this is an economic affairs debate. It was not heavily pursued, I suspect because we have a Budget in a few weeks where those issues will be fundamentally addressed. But, as the noble Lord, Lord Skidelsky, said, if the economy is not performing, you can basically tear up any of the public spending promises. It is crucial that we have an effectively performing economy.

I totally believe in creating the skills and investing in building the institutional capabilities to realise all the benefits of the fourth industrial revolution and the digital economy—but, frankly, that is incredibly non-controversial. Nobody is going to argue against that strategy; I hope it has oomph and a great deal of success. But if we want to keep people in jobs, we have to hold on to high-volume manufacturing—and that really brings us back to the negotiation with the European Union. The car manufacturers are here as part of an integrated European supply network. The supply chains that spin off them are also dependent on that network, and we have heard nothing to give that reassurance. We may well end up with a zero-tariff regime, but if there is any friction in the form of non-tariff barriers, those costs will make it very difficult to retain that supply chain.

The noble Baroness, Lady Falkner, addressed the issue of financial services—an area with which I keep in very close touch. This House will know that the industry has acknowledged spending £4 billion so far to relocate operations to continental Europe; she is quite right. The biggest beneficiary has been France, where the AMF has taken over many of the roles of the SCA, particularly in regulating trading. That £4 billion is the acknowledged amount. The industry is using this coming year to complete major relocations. I have said before in this House that when you look at financial services, the clients are in continental Europe and the capabilities to provide financial services are here. You cannot move the clients, but you can move the capabilities. So the Government must have some strategy to retain that industry.

All we have heard about so far is equivalence, which everyone in this House knows is an inadequate regime; it is highly fragmented, it does not apply to deposit taking or insurance, it frequently requires a major presence in the EU regardless of the other aspects of its agreement, it often does not guarantee market access, and if you take a look at the experience of the Swiss—who have had to become rule takers in order to maintain market access on financial services—there are key issues there. Others have talked about the creative industries and services more generally.

I have one last comment to make. The noble Baroness, Lady Bull, brought up the issue of productivity, and other noble Lords echoed it. It is absolutely fundamental. Frankly, it is appalling that, at this moment in the UK, growth in productivity is at 0.3%. That is terrible. I want to point to this because the country breaks into two sectors. Our medium-sized and small companies are very poor in terms of productivity growth. Our leading and advanced companies are brilliant; they are world beaters. Unfortunately, those are the industries for which it is most attractive to move to continental Europe or to shift their investment bias to continental Europe. So, if we are to tackle the productivity problem, we have to make sure that those companies stay and grow their operations here. That has to be central to all future trade negotiations.

NHS Pensions: Taxation

Baroness Kramer Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord raises an important point. I am afraid I do not have the specific details about NHS clinicians and academics within the university sector. I will ask about this and write to him.

[Baroness Kramer (LD)]

My Lords, the BMA makes it clear that the Defence Medical Services are the most impacted group of medics. Will the Minister confirm that we are today sending medics out to battlefields such as Afghanistan, who work all hours to serve their wounded comrades and are having to call home to tell their families to take out a second mortgage to pay an unexpected £20,000 to £40,000 tax bill, which hits them because of the peculiar pension consequences? Will this be remedied immediately?

[Baroness Blackwood of North Oxford]

I can confirm that it has been made absolutely clear that NHS clinicians have been impacted by these reforms, and front-line care has been impacted. This is unacceptable and that is why we are bringing forward the review to find a solution as quickly as possible. The noble Baroness is right to raise the issue and we are determined to resolve it.