Health and Social Care (Safety and Quality) Bill

Baroness Pitkeathley Excerpts

Friday 6th February 2015 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I congratulate the noble Lord, Lord Ribeiro, on his introduction of his Private Member’s Bill and on the clear explanation that he has given of its contents. Although it is a Private Member’s Bill, it has strong support from the Government—such strong support, in fact, that in another place the Minister was reprimanded by the Deputy Speaker for speaking at unusual length on a Private Member’s Bill. Even if the Deputy Speaker in your Lordships’ House had such powers, I am sure such reprimands to the Minister would be unnecessary today.

It is perhaps unfortunate that the wide-ranging Bill that many in the regulation world were hoping for, expecting and working towards has not found parliamentary time in this Session, although the Law Commission and Department of Health officials continue to focus on a Bill for a future Session, as the noble Lord, Lord Ribeiro, reminded us. Such a Bill with adequate parliamentary time would have given us the opportunity to discuss the whole regulatory framework, but that discussion will be for another Parliament.

I now declare my interest as chair of the Professional Standards Authority for Health and Social Care. I emphasise that it is in that capacity that I address the issues in this Bill, so I will confine my comments to Clause 5. The Professional Standards Authority for Health and Social Care promotes the health, safety and well-being of patients, service users and the public by raising the standards of regulation of people working in health and social care. We are an independent body working to Parliament and accountable to Parliament. We oversee—“audit” might be a good word—the work of the nine statutory bodies that regulate health professionals in the United Kingdom and social workers in England. We review the regulators’ performance and scrutinise their decisions about whether the people on their registers are fit to practise. We have other functions, but those are not the concern of this Bill.

The Professional Standards Authority is concerned that there is a misunderstanding of our functions and that the Bill will make our objectives unclear and contradictory and narrow the scope of our work, thus reducing our ability to promote the health, safety and well-being of patients, service users and other members of the public. I fear this is because the Bill conflates the authority’s role with the role of the regulators. The Professional Standards Authority is not a regulator; it is an oversight body and has no direct relationship with the professionals regulated by the nine regulators. In fact, I do not think it is too strong to say that the Bill muddles the role of the Professional Standards Authority with the role of the regulators, and in doing so is likely to provide less public safety and quality rather than more, which is its aim. Let me expand on that a little.

The authority’s current objective requires it to promote the health, safety and well-being of patients, service users and other members of the public. This formulation provides a helpful clarity that our focus should be on patients and service users first and foremost. This emphasis, of course, reflects the findings of former and recent inquiries—Bristol, Shipman and Francis—and it is vital to maintain that emphasis. Indeed, the noble Lord who introduced the Bill has also emphasised how important that emphasis is. This is particularly helpful given that “the public” includes, of course, the professionals whom the regulators regulate. We have to think about the impact of decisions and policies on individuals, as well as take account of the impact on the wider public. In our Section 29 work, for example, when we review a regulator’s decision about a case we consider it in relation to the individual patients treated or seen by the health professional, and we also consider the wider public interest implications of the case.

I do not understand why it is considered necessary for Clause 5 to refer to “the public” rather than to patients, service users and other members of the public, or what additional benefit would be gained. It seems an unnecessary and unhelpful contraction that reduces our focus from individuals and population to population alone. I would be glad to receive an explanation from either the Minister or the noble Lord of why that is considered necessary. I must seek a strong assurance from the Minister that this change will never take the focus of the Professional Standards Authority away from patients and veer it towards the interests of professionals. When the Council for Healthcare Regulatory Excellence was established, and since then in launching the Professional Standards Authority, we have constantly emphasised the patient and user focus of our work, and we do not wish to put that focus at risk in any way.

I have further concerns about the Bill setting up competing objectives for the authority when we identify a poorly performing regulator, which is what our performance process aims to do. Currently, the authority has no role in promoting and maintaining public confidence in the professions regulated by the regulatory bodies. That is for the regulatory bodies themselves to do. Here again, I am concerned that the Bill conflates the role of the authority with that of the regulators. If the Professional Standards Authority is required to protect, promote and maintain the health, safety and well-being of the public by reporting the poor performance, followed, we hope, by improvement in the regulators, as proposed new subsection (2B)(a) requires, could it not also be said that the public would be better protected if the regulators’ poor performance was not reported, because highlighting it might harm public confidence in the profession it regulates and consequently increase the risk of people not seeking and trusting treatment and care when they need to do so? If a conflict between these two objectives arises, we need to be assured by the Minister that the Professional Standards Authority’s priority will always be understood to be to protect, promote and maintain the health, safety and well-being of patients and public, not that of the professionals who deliver the care.

Under current legislation our role is clear, as I have set out. I am sorry that the Bill raises questions about the clarity of that role, and I repeat that I think this has occurred because of muddling the role of the authority with that of the regulators. My aim is to ensure that the authority’s role is entirely understood to be for the benefit of patients, users and members of the public. I seek the Minister’s reassurance on the points I have raised.

That is all that I wish to say about Clause 5, but I cannot sit down without registering my dismay at the way in which the Bill is being handled in your Lordships’ House. We are all realistic enough to know about government hand-out Bills, but a government “take it or leave it” Bill is another matter. It is not acceptable to be told by officials, not Ministers, not only that the Bill cannot be amended but that we cannot have a Committee stage for the discussion, negotiation and scrutiny that is such a proud tradition in your Lordships’ House. There are some complex and difficult issues in the Bill that could affect patients for years to come. The parliamentary process should not be short-circuited for the convenience of business managers. We would be failing in our duty as a revising Chamber if we agreed to that.