Health and Social Care Bill

Debate between Lord Harris of Haringey and Lord Mawhinney

Monday 7th November 2011 Lords Chamber

[Lord Harris of Haringey]

My Lords, when I was director of the Association of Community Health Councils, the message from community health councils around the country was that people who complained were seeking not compensation from, or retribution against, those who had perhaps caused the reason for their complaint—for example, the death of a loved one—but information. They wanted to know what had happened, and they wanted some reassurance that what happened to them or their relatives would not happen again.

Always, the most tragic cases were those in which people had not known what had happened and discovered the actual circumstances only much later, perhaps when their relative’s case came to an inquest or, in some cases, even long after that. I would like to hope that, in the 10 years or so since I was director of the Association of Community Health Councils, this problem would have become less, but it remains a serious blemish on the health service that, too often, such mishaps are covered up.

In a case reported only three weeks ago—the most recent case that I have come across, but I am sure there are many others—a mother discovered long afterwards that the death of her seven year-old daughter, which she had blamed on herself for not being able to perform the necessary first aid, was actually the consequence of a failure by a paramedic called to the scene. She discovered that only ages afterwards when she became aware of the transcript of the inquiry which led to the paramedic being dismissed. That case, reported in the Doncaster Free Press only three weeks ago, is an indication of the sorts of incidents that one is talking about.

I met the family of someone who had died while detained in a secure mental health facility. They discovered the circumstances in which their loved one had died only when the matter was reported at an inquest. In such incidents, the health service officials knew what had happened and had conducted their own inquiries but did not think it necessary or appropriate to tell the families concerned. That is why it is so important to have this amendment, which would place a statutory duty of candour on the health service, to make it something that runs right the way through the system.

Of course, accidents can never be eradicated. Healthcare is of its very nature a risky business and health professionals are only human, so these things will happen. However, what is unforgiveable is that the fact that something has gone wrong is not told to those concerned. The noble Baroness, Lady Masham, quoted Sir Liam Donaldson, but I thought that she was also going to quote the maxim that he gave:

“To err is human, to cover up is unforgiveable”.

That is precisely the concern that motivates this amendment.

In the White Paper Equity and excellence: Liberating the NHS, the Government said that they will require hospitals to be “open and honest” when things go wrong. That stems directly, I think, from the Liberal Democrats’ manifesto commitment, but, unfortunately, their manifesto referred only to hospitals rather than to the wider health service. I think that the Liberal Democrats intended that such a duty should be statutory, but my understanding is that the Department of Health is looking at this as something that could be written into contracts. As the noble Baroness, Lady Masham, has pointed out, having a lesser status than a requirement to inform a central agency that something has gone wrong would mean a lesser status in terms of informing the family. It is really important that we look at this issue and take it seriously, so I hope that the noble Earl will accept the amendment.

In 2005, a National Audit Office report revealed that only 24 per cent of NHS trusts routinely informed patients of a patient safety incident—that implies that more than three-quarters of NHS trusts do not do so routinely—and 6 per cent admitted that they never informed patients of a patient safety incident. Quite clearly, there is a “culture of denial”. Noble Lords may think that that is rather an alarmist statement, but I am simply quoting from a Department of Health document from 2006.

[Lord Mawhinney]

My Lords, I am extremely grateful to the noble Lord for giving way. I do not want him to interpret my question as opposition to the general point that he is making, but before he finishes will he say a word about the role of lawyers of health service bodies in these circumstances? I am not a lawyer, as I have told the House before, but in both cases that he has cited I could see legal advisers saying, “Say nothing”. If we are to take this amendment seriously, we need to have some idea of what part the law might play if the Bill were to be so amended. As the noble Lord has experience, I would be grateful if he would reflect on that.

[Lord Harris of Haringey]

My Lords, the noble Lord, with all his experience—albeit, like me, as a non-lawyer—is speaking exactly the truth. In many of those cases, the legal advice would be, “Say nothing”. There therefore needs to be a statutory duty, because then the responsibility of the lawyers concerned would be to advise, “There is no option but to tell the patients or their families”.

An interesting point is that insurers in the United States often require open disclosure policies and practice by health providers to qualify for insurance. The international evidence is that, as well as being the right thing to do morally and ethically, being open and honest when things go wrong can actually reduce litigation and complaints.

My concern is that the Government will say that they are doing enough by saying that the duty of candour can be achieved through a contractual process. However, as the noble Baroness, Lady Masham, has pointed out, this would apply only to hospitals with an NHS contract; it would not apply to GPs, dentists, pharmacists or private healthcare providers. I do not see why the duty of candour to patients and their families should be regarded as of lesser importance and impact than those things where there is direct regulation. I hope that the Minister will say that the Department of Health will take this away and that he will come back to the House with proposals to give a statutory duty of candour to protect the interests of patients.

Health: Cancer

Debate between Lord Harris of Haringey and Lord Mawhinney

Wednesday 2nd March 2011 Lords Chamber

[Lord Mawhinney]

My Lords—

[Lord Harris of Haringey]

My Lords—

Parliamentary Voting System and Constituencies Bill

Debate between Lord Harris of Haringey and Lord Mawhinney

Monday 10th January 2011 Lords Chamber

[Lord Harris of Haringey]

I am merely saying that some people—the noble Lord, Lord Rennard, is clearly one of them—believe that there is such a conspiracy. I can assert that I am not part of any such conspiracy, if one even exists. I wanted to speak today specifically because of the importance of considering the nature and character of representation. This is the issue to which the noble Lord, Lord Elystan-Morgan, referred, and on which I intervened previously, not in Committee but when we debated in the Chamber the Bill’s potential hybridity and what it is about a locality that underpins the nature of representation.

While we may have had the silence of the lambs on the Benches opposite, with the notable exception of the noble Lord, Lord Tyler, and the noble Lord who has just intervened on me, what has been most notable about the discussion is the dogs that did not bark—the specific issues. The amendment provides an opportunity for those points to be considered in depth. The dogs that have not barked are serious debates about the nature of representation and of Parliament, and about what we want the House of Commons and Members of Parliament to do and how we want them to operate.

The issue of optimum size is critical, but we have not debated or discussed it in any real detail; the number appears to have been offered down from on high without any consideration. I have not had the privilege of being an elected Member of the House of Commons, but I was an elected public representative in London for 26 years. For part of that time I was the directly elected representative of 5,000 people in the Hornsey central ward of the London Borough of Haringey. For part of that time I was the directly elected representative of the people of Brent and Harrow, a constituency with an electorate of something like 400,000. I have therefore had experience of two extremes of the nature of representation, and the 400,000 figure is probably more consistent with the size of the constituencies of the United States Congress.

My point is not that I am advocating one or other as being the norm for the House of Commons; I am simply saying that there is a world of difference between the type of representation at the lower end of that scale and the type at the higher end. To pretend, therefore, that there will be no difference whether Members of the House of Commons represent 50,000, 60,000, 70,000 or 90,000 people is ludicrous. There has to be recognition of the nature of the relationship between constituents and their Member of Parliament, and that seems to be lacking in the Bill.

[Lord Mawhinney]

I have had the privilege of serving in the other place. I started immediately after a boundary redistribution with 60,000 to 65,000 constituents, and finished up with 95,000. I hope the noble Lord is not suggesting that in the latter years my constituents got a worse service.

[Lord Harris of Haringey]

No, my Lords, I am suggesting that the noble Lord no doubt had to work 50 per cent harder to deliver the service that he regarded was appropriate at the beginning of his time in the other place. That is fine, but we ought to—